Pertinent Federal Law Review Pertinent to Florida Licensed Insurance Professionals
Each state’s insurance director manages most insurance issues and products at the state level. There are, however, instances in which the state and federal governments work together, for example, Medicaid is a state and federally funded program.
State and Federal Relationship
There is a relatively new (3-years) Federal Insurance Office (FIO) that was created by the Dodd-Frank Wall Street Reform and Consumer Protection Act (DFA), which, so far, has allowed states the same freedoms as before creation of the FIO.
The fall of the economy, during which we endured the exposure of an insurance industry debacle, played a significant role in Title V of the DFA. It created the FIO and appointed a director who had previously been the acting Insurance Director in Illinois, and an officer for the NAIC. This appointment allowed a voice for the state-run industry and, as the director said during his first press conference, the FIO has refrained from stepping into state lines. He can, however, intervene if a reasonable request is made. The FIO authorities extend to all lines of insurance except health and LTC insurances (except those lines of insurance included with life or annuity components).
Although the FIO states, “authority extends to all lines except health … “ we can hardly call the Affordable Care Act “health insurance without federal input!” We have been virtually hit over the head with volumes of Affordable Care Act documentation, rules, policies, and dates. The Act is set to run on a rolling calendar, which results in yearly changes to the rules you become accustomed, each time January 1st rolls around.
Registration for Index-Linked Annuities Act
This bill requires the Securities and Exchange Commission (SEC) to create a new form for the registration of index-linked annuities to ensure that a purchaser can make a knowledgeable decision.
The bill defines a registered index-linked annuity as an annuity that is deemed a security, that must be registered with the SEC, and that is issued by an insurance company subject to state supervision. Furthermore, the returns of these annuities:
- are based on the performance of a specified benchmark index or rate, and
- may be subject to a market value adjustment if amounts are withdrawn early.
Affordable Care Act Open Enrollment 2023
In 2023, some changes to the Affordable Care Act (ACA) took effect. The “family glitch” is fixed. Up until 2023, an estimated 5.1 million people were ineligible for marketplace subsidies because of the family glitch. Generally, people were ineligible for marketplace subsidies if the family had an offer of affordable job-based coverage which included through a family member’s job. Up until 2023, the affordability of job-based coverage for a worker’s spouse and dependents only measured the premium contribution required for the worker’s self-only coverage. Therefore, if an employer coverage offer met the affordability threshold (9.12% of income in 2023 and 8.39% in 2024) for self-only coverage but not for family coverage, those family members were considered to have an offer of affordable job-based health coverage and locked out of ACA marketplace subsidies. The new rules took effect for the 2023 coverage year, measuring the affordability of family coverage based on the worker’s premium contribution for family coverage. If that amount is more than 9.12% of household income in 2023 (8.39% in 2024), family members will have the option of buying health coverage through the Marketplace and will be eligible for premium tax credits based on their income.
Another change is Marketplace eligibility rules have been relaxed on HealthCare.gov. During the Trump Administration, insurers offering policies on HealthCare.gov were permitted to refuse to renew coverage for people who had fallen behind on premium payments. For 2023, that is no longer the case. People who fall behind on premium payments (or even lapsed coverage due to nonpayment) will still be able to enroll in a policy offered by that insurer; and the binder payment (the January monthly premium payment) required to effectuate coverage cannot be applied to past-due premiums. Another change is that once Open Enrollment ends, people will continue to be able to sign up for Marketplace coverage mid-year if they have a qualifying life event (such as loss of other coverage, marriage or divorce, or a permanent move) using a 60-day special enrollment period (SEP). Effective in 2023, HealthCare.gov will only require pre-enrollment verification for SEPs due to loss of other prior coverage. For other qualifying events (marriage, divorce, permanent move, etc.) people will be able to self-attest to their eligibility and continue to enroll in coverage during their special enrollment period.
Key Takeaways
As of 2022, four insurers joining the exchange; Average approved rate increase for existing insurers is 6.6%. There were be 14 insurers offering plans in Florida’s marketplace, including the four new insurers. As is the case in most states, insurer participation varies from one area of the state to another.
Florida Blue does not allow agents to show clients other insurers’ plans. Oscar sued to block this, but a judge dismissed the case. So Florida Blue can continue to require agents to sign exclusivity contracts (Oscar appealed but later dropped the case).
2.1 million people enrolled in private plans through Florida’s exchange during the open enrollment period for 2021 coverage; that’s the highest enrollment in the country, and the third year in a row with record-high enrollment in Florida’s exchange.
Short-term health plans can be sold in Florida with initial plan terms up to 364 days.
Florida consumers are protected against surprise balance billing
Bright Health exits Florida Marketplace for 2023, while AmeriHealth joins. Nearly all counties have 5+ insurers offering plans for 2023 (Oscar plans cannot be selected after December 12, 2022)
Source: https://www.healthinsurance.org/florida-state-health-insuranceexchange
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