Producer of Record Discussion Producer Advisory Council June 26, - - PowerPoint PPT Presentation

A service of Maryland Health Benefit Exchange

Producer of Record Discussion

Producer Advisory Council – June 26, 2013

Maryland Health Connection will capture changes and send to carrier Maryland Health Connection may include language to confirm the change and to ensure the employer understands the implications of the change Proposed effective date for Producer of Record changes is first of the month following 30 days No retro Producer of Record changes No future dated Producer of Record changes An email notification will be sent to the old producer informing them of the Producer of Record change

Producer of Record Procedures

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DRAFT for discussion – subject to change

Producer of Record change - only during open enrollment or at a special enrollment time Individual Exchange – Producer of Record Change

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DRAFT for discussion – subject to change

Must be initiated by the group One Producer of Record change per year SHOP Exchange- Producer of Record Change

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DRAFT for discussion – subject to change

Under Special circumstances the state administrator can make a Producer of Record change – Producer death – Retirement – License revoked – Etc.

Producer of Record Change

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DRAFT for discussion – subject to change

TPA of record change must be initiated by the Producer All certified TPAs can be selected by the Producer Producer can change TPAs at any time Require language next to TPA selection that the Producer must select the correct TPA prior to selection (maybe a confirmation page) When TPA receives information from Maryland Health Connection, they must confirm that the Producer on the file is a current contracted Producer

SHOP TPA of Record Change

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DRAFT for discussion – subject to change

Do the timeframes make sense? Is there anything else that we should consider?

Discussion Questions

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DRAFT for discussion – subject to change

SHOP Minimum Participation Interim Procedure

SHOP Minimum Participation Interim Procedures

Minimum Participation: Employer Choice Option: A Carrier may impose a minimum participation requirement of no greater than 75% of eligible employees of a Qualified Small Employer participate in the designated coverage level selected by the Qualified Small Employer. Employee Choice Option: MHBE may impose a minimum participation requirement of no greater than 75% in the SHOP

DRAFT – Information Subject to Change 9

SHOP Minimum Participation Interim Procedures, Continued

Waivers are being considered for the following: Those who have group spousal coverage under a public or private plan of health insurance or another employer’s health benefit arrangement; and Employees who are under the age of 26 years who are covered under their parent’s health benefit plan. We also considered participation on Maryland Health Connection but removed that from the proposed interim procedure.

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