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COHBE Qualified Plan Certification. SB-200 Requirements.

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Sb 200 requirements
SB-200 Requirements

  • CRS 10-22-104The exchange shall not duplicate or replace the duties of the commissioner established in section 10-1-108, including rate approval, except as directed by the federal act. The exchange shall foster a competitive marketplace for insurance and shall not solicit bids or engage in the active purchasing of insurance.

  • CRS 10-22-106(1)

    • (i) Consider the unique needs of rural Coloradans as they pertain to access, affordability, and choice in purchasing health insurance;

    • (j) Consider the affordability and cost in the context of quality care and increased access to purchasing health insurance; and

    • (k) Investigate requirements, develop options, and determine waivers, if appropriate, to ensure that the best interests of Coloradans are protected.



Plan management
Plan Management

  • Certification, recertification, decertification

    • Regulatory requirements

    • Accreditation standards

  • Business Relationship

    • Data exchange standards

    • Customer service standards

  • Exchange will develop objectiveplan management standards and communicate those standards to carriers before certification.


Exchange partners
Exchange Partners

  • Exchange will work with Division of Insurance, Department of Public Health and Environment, and Department of Health Care Policy and Financing to minimize QHP burdens





Decertification
Decertification

  • The Exchange will only decertify an issuer during the year if the issuer is not able to meet responsibilities (loses licensure, insolvency, or inadequate network, etc.)

    • The Exchange will work to move members to a new QHP in an efficient manner

  • An issuer who fails to meet necessary business partnership levels will not be recertified but members will continue to be enrolled in the QHP


Recertification
Recertification

  • The Exchange will develop an annual recertification process

  • The recertification will allow the Exchange board to change the baseline certification processes in future years


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