Balancing consumer protection, innovation is focus of new health insurance rules

Balancing consumer protection with innovation is the focus of the new rules under consideration for new health insurance plans that will be available in 2015.

The Insurance Commissioner’s office has been working on the health insurance network rules for more than four months. The process began soon after the emergence of what are called “narrow networks.” That’s the common reference now to health plans that don’t always include the doctors and hospitals that insurance companies typically contracted with in the past before the Patient Protection and Affordable Care Act took effect this year.

While still providing access to a full range of medical providers, health insurers have said they have not contracted with some traditional doctors and hospitals because of the higher rates they charge for some services. It’s a key way that insurers have said they can keep premiums lower for consumers and still maintain comparable quality care – especially considering the often wide discrepancies in what providers charge for the same service.

Insurance Commissioner Mike Kreidler saw early on that consumers and providers needed more guidance in developing health plans for 2015. The new rules under consideration are heavily focused on providing more transparency – answering the common question: “Is my doctor and hospital in the network of the health plan I might buy?”

“Consumers have a right to know,” Commissioner Kreidler told the members of the Health Benefit Exchange at its monthly public meeting March 27. “It’s my job to ensure that consumers can access the care they need and that insurers live up to their promises.”

That hasn’t been as clear as it should have been through plans offered this year. The new rules are designed to give consumers more information on which to make choices in 2015.
The commissioner has heard from a wide range of interested parties, including insurance companies, doctors, consumer advocates, Indian tribes and more.

A public hearing on the rules is scheduled for April 22 in Olympia. They are set to take effect May 1, about the same time that insurers will begin proposing new plans. Considerable flexibility is built into the new rules to make sure that health plans for 2015 are given time to comply. The fact is, health insurers have been involved in the process for months. And much of what’s being asked for in the rules is already required.

The new rules are simply providing a formal and clearer roadmap for all to follow on behalf of consumers.