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The following questions have been received by the Idaho Department of Insurance regarding the Idaho Health Insurance Exchange and SHOP (Idaho Exchange), the filing process, Qualified Health Plan standards, and other related topics. The answers are intended to offer guidance on current issues based on the DOI’s current understanding of applicable federal and state law requirements. If you have any concerns regarding the accuracy of any of the guidance, please contact Wes Trexler at the DOI by phone at 208-334-4315 or email. The DOI will continue to release additional information and revise these responses as needed.

Check out our other ACA FAQ pages: 2013, 2014, 2015, 2016/2017, 2018
Are there any changes to the QHP standards for 2015?

Due to SERFF binder functionality delays, will the DOI change the deadlines from what is presented in the 2015 QHP Standards document distributed April 21, 2014 by the Idaho DOI?

Have you established a filing deadline for off-exchange plans for the 2015 plan year?

Will the off-exchange open enrollment period for the 2015 calendar year coverage differ from the on-exchange open enrollment period of November 15, 2014 through February 15, 2015?

What is the Idaho exchange user fee for the 2015 plan year?

Does Idaho require a health plan to embed the pediatric dental benefit when off the exchange, and what is considered reasonable assurance?

When can plans be added to either the individual or small group market?

Are small group composite premiums allowed at certain group sizes, as long as the total is equal to the allowable per-member rating at issue and renewal?

Will YHI allow premium aggregation (employee choice) in the SHOP during 2015?

What requirements exist for brokers / producers who wish to participate in YHI?

How do federal regulations change how Idaho carriers determine if an employer qualifies as a small group in 2015?

Are rate manuals required to be included as part of a QHP rate filing?

Do carriers need to submit the federal rating business rules template in 2015?

Do carriers need to submit the federal network adequacy template in 2015?

Are there recommended changes to the default add-in EHB information provided in the federal plans and benefits template?

Are enrollees of the Idaho Individual High Risk Pool plans eligible for a special enrollment period upon reaching the maximum lifetime benefit per carrier, allowing the individual to enroll in 2014 ACA-compliant health plan?

Are the Idaho Individual High Risk Pool plans considered minimum essential coverage?

What templates are required for on-exchange plans and what templates are required for off-exchange only plans?

Can adults purchase a stand-alone dental plan on YHI?

Will YHI display in the shopping experience stand-alone dental plans designated as either “Allows Child-Only” or “Allows Adult and Child-Only” within the plans and benefits template?

Regarding stand-alone dental plans, will YHI allow the “household” composite rating tiers (Individual, Couple, Couple and Children, Family, etc.) or only the per member rating by age?

Regarding stand-alone dental plans, will YHI distinguish between “guaranteed” and “estimated” rates?

Is the Carrier Acknowledgement & Consent to Publishing of Rate Information and Determination form required for stand-alone dental plans wishing to be exchange-certified?

Since accreditation is not a requirement of stand-alone dental plans, how should a SADP demonstrate network adequacy?

On September 12, 2014, CMS released Revised Bulletin #10 on Grace Periods Related to Terminations for Non-Payment of Premiums and Enrollment through the Federally-facilitated Marketplace across Benefit Years.” The bulletin specifically applies to Federally-facilitated Marketplaces, and therefore is not directly applicable to Idaho. How does the DOI interpret the regulations regarding a grace period that crosses benefit years?

Are there Idaho standards regarding the acceptance of incomplete binder payments to effectuate coverage?

Regarding renewing coverage, are there situations in which the carrier could require a new binder payment prior to processing the renewal?

Idaho’s small employer Basic, Standard, and Catastrophic plans, as described in IDAPA 18.01.70, do not qualify as grandfathered plans, and the plans do not meet ACA requirements to be sold as non-grandfathered coverage after January 1, 2014. Therefore, what options do carriers have regarding these plans mandated by Idaho Code § 41-4708?

How does the DOI interpret and intend to enforce the new requirements for fixed indemnity plans in the individual market, as described in the Market Standards final rule, published May 27, 2014?

Do group health plans that do not include in-patient hospitalization services meet minimum value requirements if the plan provides at least a 60% value, as determined using the Minimum Value Calculator?

If your question is not answered above, please submit your question directly to the DOI.

Check out our other ACA FAQ pages: 2013, 2014, 2015, 2016/2017, 2018

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