Implementation of the ACA in Puerto Rico
4/24/2015 HEALTHCARE REFORM IN PUERTO RICO OFFICE OF THE COMMISSIONER OF INSURANCE MARIELBA JIMENEZ COLON APRIL 30, 2015 HCCA - 2015 SAN JUAN REGIONAL AREA COMPLIANCE CONFERENCE Mission Office of the Commissioner of Insurance To promote the solvency, reliability, and competitiveness of the insurance industry as a vital sector of the economy of Puerto Rico through the development of an agile, innovative, and flexible regulatory system that encourages the satisfaction of consumers’ insurance needs and the protection of the public interest. Specifically related to health insurance, our misión is to regulate and promote consumer access to health insurance. Implementation of the ACA in Puerto Rico 1. Communications from HHS to Puerto Rico – ACA provisions that amend the PHSA apply to health insurance sold in Puerto Rico. ACA provisions that do not amend any other law do not apply to Puerto Rico. 2. The Health Insurance Code of Puerto Rico, Act 194-2011 as amended. (“HICPR”) 3. Act 69-2013 of July 22, 2013 New Chapter 10 to the HICPR for the individual market. 1 4/24/2015 Implementation of the ACA in Puerto Rico 4. HHS’ Ruling - July 16, 2014: Changed interpretation about the application of ACA to Puerto Rico. 5. Excluded 6 provisions of ACA: Guaranteed Availability Community Rating Rate Review MLR EHB Single Risk Pool Open Enrollment Results – Covered Persons 80,000 60,000 40,000 20,000 0 Covered Persons Uninsured Individual Individual 2013 2014 Uninsured Small Group 2013 Small Group 2014 Covered Persons ACA Compliant Available Coverage by Health Plans Approved 2013 Approved 2014 250 250 200 200 150 150 100 100 50 50 0 0 Bronze Silver Gold Platinum Individual Plans - 91 Small Group Plans- 358 Bronze Silver Gold Platinum Individual Plans - 37 Small Group Plans - 269 2 4/24/2015 Health Insurance Industry Results % Gross Written Premium (14.6) Loss & LAE (14.0) (3.9) Administrative Expenses (155.3) Underwritting Gain (Loss) Investment Income 10.2 Net Income (165.3) Capital & Surplus (18.9) GWP/Capital & Surplus (5.0) MLR 4.8 Administrative Expenses Ratio -500 In Millions (12.2) 0 500 1000 1500 2000 2500 3000 3500 4000 4500 September 2013 September 2014 Bill P de la C 2413 or P del S 1354 The OCI is currently reviewing legislation to amend the HICPR on these topics: Guaranteed Availability Alternative Health Plans Single Risk Pool Community Rating Bill P de la C 2413 or P del S 1354 The OCI is currently reviewing legislation to amend the HICPR on these topics: Rate Review MLR Association Coverage 3 4/24/2015 Other Bills Other bills related to Health Insurance: • • • P de la C 1576 - TPA P de la C 1991 / P del S 1123 - Health Insurance Rates Reviewing Board P de la C 1518 / P del S 817 - Incentive programs for providers Commissioner’s Rulings • CN-2014-177-D - Enmienda a Carta Normativa CN-2013-161-D del 18 de Noviembre de 2013, Sobre Nuevas Normas Para el Proceso de Transición Aplicable a Ciertas Renovaciones de Planes Médicos Durante el Año 2014. • CN-2014-178-D - Extensión del Proceso de Transición Aplicable a Ciertas Renovaciones de Planes Médicos. • CN-2014-185-D - Extensión del proceso de transición hasta el 31 de diciembre de 2016. • CN-2015-187-AS - Radicaciones de Formularios y Tarifas para el Año Natural 2016 Thank You 4
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