Broker blog from Delta Dental

Tag: Stephanie Berry

Policy pops: The long and short of short-term health plans

3‑minute read

Join our guest blogger, Stephanie Berry, as she answers frequently asked questions about short-term limited duration health insurance plans (STLD). Stephanie is a Senior Legislative and Policy Analyst based in Rancho Cordova, California.

On October 2, the U.S. Department of Health and Human Services (HHS) put new rules into effect lengthening the maximum duration for short-term limited duration health insurance (STLD). Prior to the enactment of the Affordable Care Act (ACA), STLD plans were prevalent in the individual market for people who experienced temporary gaps in health coverage, such as losing or changing a job. Unlike “limited benefit” policies, such as cancer-only or hospital-only policies, STLD plans were considered akin to comprehensive medical plans, only differing in their limited term, previously 90 or less days. The new HHS regulations increase the duration of STLD plans, potentially making them more appealing to certain demographics, particularly younger, healthier consumers.

FAQ:

Q: How long can these new STLD plans last?

A: The new rules state that a short-term plan can last up to a year (364 days), and consumers will be able to renew that plan for a maximum of two additional years (up to 36 months). This is a change from the federal rules, which previously limited STLD plans to three months. Individual health plans have been guaranteed renewable since 1996, whereas STLD plans previously terminated at the end of the contract, meaning that a change in health status could cause policyholders to be dropped from coverage.

Q: Do STLD plans have to follow the same ACA rules regarding medical underwriting, pre-existing condition exclusions, etc.?

A: No. The ACA exempted STLD plans from market rules. As a result, the following are permissible under STLD plans:

  • Medical underwriting: Applicants can be excluded or charged higher premiums based on health status, gender, or age
  • Excluding coverage for pre-existing conditions
  • No coverage for essential health benefits that ACA-compliant plans must cover, such as pregnancy, prescription drugs, or mental health care
  • Lifetime or annual limits
  • No limit to out-of-pocket expenses

Q: Can dental be offered as an STLD product?

A: STLD products are meant to compete with major medical plans, and, as a result, there is not a clear role for stand-alone dental carriers in the STLD space.

Q: How do STLD plans differ from Association Health Plans?

A: Think of Association Health Plans as a way for members of associations to band together to purchase large group health insurance. As a result, an AHP could choose an STLD plan as the health insurance plan it offers to its members.

Q: What role do states play in regulating STLD products?

A: States can take action to comply with the new STLD regulations or implement their own restrictions and guidelines, many of which are already enshrined in state law. Brokers should reach out to state departments to understand any additional state requirements. Here are a few examples on how states are reacting to the new STLD regulations:

  • Four states currently prohibit STLD plans, including Massachusetts, New Jersey, New York and California (SB 910 in California was signed by the governor in September). Relatedly, Hawaii enacted a law this year (HB 1520) that bars residents from enrolling in STLD policies if they are otherwise eligible to purchase coverage from the federal health insurance marketplace during an open or special enrollment period. It also limits the duration of an STLD policy to less than 91 days.
  • States can – and have – adopted shorter maximum durations of an STLD policy. For instance, the South Carolina Department of Insurance has restricted STLD policies to 11 months or less, and limits renewals to a total of 33 months or less coverage. (This is intended to distinguish STLD policies from ACA-compliant policies.) Michigan, by contrast, limits STLD policies to six months or less out of any 365-day period.
  • States can impose requirements on disclosure and marketing. The Maine Bureau of Insurance issued a bulletin stating that when offering an STLD policy, a carrier or broker must provide clear language that the policy does not offer protections from pre-existing condition exclusions or guaranteed renewability. Both Nebraska and Iowa require a “free-look” period, whereby the newly-insured can cancel the policy within a set timeframe.
  • States can require STLD products to cover essential health benefits (EHBs) or other ACA-market protections. The Connecticut Insurance Department issued a bulletin to clarify that STLD plans must cover EHBs, and that any renewable STLD plan or any STLD that has a duration of six months or longer is prohibited from excluding coverage for pre-existing conditions. Maine law requires STLD plans to cover preventive health services and bars dollar limits on coverage.

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Plain language policy: States move forward to stabilize insurance markets

Join our guest blogger, Stephanie Berry, as she unpacks state reactions to the removal of the ACA’s individual mandate. 

Stephanie is a Senior Legislative and Policy Analyst based in Sacramento, California.

As we reported recently, ending the penalty for individuals who choose not to purchase medical coverage (the individual mandate) could further destabilize the individual market. However, state policymakers aren’t waiting for further federal action on the ACA — leading to a notably active regulatory year as states are taking matters into their own hands. Here’s a summary of activity:

Weakening ACA regulations

Idaho unveiled a plan that openly defies the ACA by announcing earlier this year that the state would allow health plans to be offered that don’t comply with the ACA’s regulations on pre-existing medical conditions, essential health benefits, annual caps on benefits, and other key tenets of the law. These plans, of course, would be quite a bit cheaper than ACA plans and are designed to attract younger, healthier individuals. Because Idaho announced its intention to skirt ACA regulations, the federal government responded that it would step in and enforce the law if the state followed through with its plan.

Similarly, the Iowa legislature enacted a bill that allows non-ACA compliant plans to exist by creating an exemption for plans offered by the Iowa Farm Bureau, an association that is meant to serve Iowa’s farmers. To pass federal muster these plans cannot be called health insurance and therefore, cannot be regulated by the federal government or the Iowa Department of Insurance. It is likely that we will see other states follow suit.

Establishing reinsurance programs

Several states have introduced legislation to create state reinsurance programs — a way for carriers offering individual health insurance to get compensated for covering high healthcare costs. While bills are making their way through the legislatures in Louisiana, New Jersey, and other states that would require the state to apply for a federal waiver, Maryland has already enacted legislation that will support a reinsurance program by levying a surcharge on medical and dental carriers. This enacted legislation was designed to mirror the federal tax that was suspended for 2019.

Imposing state individual mandates

Finally, state legislatures — particularly those with state-based exchanges — are attempting to impose their own individual mandate that would require individuals to maintain health care coverage or pay a penalty. Legislation has been introduced in Connecticut, Vermont, New Jersey, Maryland, and Washington, but currently, only New Jersey’s bill — AB 3380 — appears close to enactment, while the bill in Washington has already died. It remains to be seen whether these individual mandate bills will be able to gain more traction this year or next.

Stay tuned for more health care policy updates from Delta Dental, and get to know our policy experts.

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Plain language policy: Spotlight on Public Affairs

Health care policy can be confusing. Really, really confusing.

That’s why we want to share periodic policy updates and insights with you — in plain terms. No jargon, no nonsense. To kick off our Plain Language Policy series, we’d like you to meet two of our key policy players, Stephanie Berry and Devin McBrayer.

Stephanie Berry and Devin McBrayer headshots

 

Tell us a little about yourself. Your educational background, past work experience, personal accomplishments, etc. 

Stephanie: I have worked at Delta Dental for five and a half years in government relations – primarily handling legislative analysis.

Before coming to Delta, I worked for California Primary Care Association (CPCA) for five years, representing clinics that mostly serve the uninsured and underserved. At CPCA, I was the Assistant Director of Federal Affairs, so I ensured everyone was educated on the Affordable Care Act and what that would mean for them. I really enjoyed doing that.

I started in advocacy and legislation working for Congresswoman Doris Matsui. I worked in her district office, doing a lot of healthcare outreach and that got my feet wet to move toward straight advocacy.

Devin: I also came from Doris Matsui’s office, which is how I met Stephanie. Before that, I worked in D.C. for Congresswoman Lois Capps on the Energy and Commerce Committee. I focused on health policy, assisting with health reform bills and analyzing them before coming to Sacramento.

I have a Master of Public Health (MPH) from George Washington, and being in D.C. was a great experience to see first-hand how legislation is made and how it goes through the regulatory process. So I know how to analyze things here when they come across the table.

Before we’re all work and no play, what do you like to do for fun? What are your hobbies or interests outside of work?

Stephanie: I’m an avid skier; my husband snowboards and the kids ski. Living in Sacramento, we’re close to Sierra Nevadas, so we get to play in the snow, but we don’t have to live in the snow. It’s nice!

Devin: I’m into biking. I live in a super small apartment downtown, but we have four bikes. I also love to hang out with my dog.

Okay, so getting down to business, what is your role at Delta Dental? 

Stephanie: We keep track of new legislation and regulations that affect our enterprise companies. Because our brand is in 15 states plus D.C., that’s where we spend most of our focus. We have lobbyists in each of these states. We write letters of support or opposition and take part in advocacy activities.

We’re also part of the National Association of Dental Plans (NADP) and America’s Health Insurance Plans (AHIP), which help us advocate on the issues happening in states where we don’t have as much presence.

In 2017, we tracked 750 bills. More than 5,000 bills come up in our search topics, and we narrow those down to those that might affect us. 150 of the 750 were signed into law; 50 of those affected us.

What is it like having a direct impact on health policy and legislation? 

Stephanie: It’s feeling like you can make a difference. You can work with constituents when working for a congresswoman. You see the impact. In this role at Delta Dental, it’s writing a support or opposition letter and seeing your advice taken into account.

Devin: Stephanie and I both really enjoy politics and the legislative process. It’s a hobby to be involved. Being active in the political process and analyzing legislation and regulations might seem intimidating to some people, but we enjoy digging through them. With our background, sometimes we are lucky in that we intuitively understand the way a bill may have been designed a certain way and why. We just think it’s fun!

It sounds like you get to have fun for a living. What jumps out as making your work worthwhile?

Stephanie: Coming to this job being raised in California, it’s so interesting learning how other states think. I enjoy going to the Capitol in other states and learning that different perspective. The fact that we have people with boots on the ground in all these states is so helpful. I even went to Montana this year, and partnered with Jim Dole (Sales Account Executive). He was so great at explaining how things tick there. I love learning the history. And I was in Atlanta advocating on a bill recently – that perspective keeps things interesting.

Since you’re new to Delta Dental, what are some of your first impressions? What do you like most about your job so far?

Devin: I most enjoy the team I work with; they understand my background. We’re all equally passionate about the work we’re doing and we all want to be as helpful as possible to other business units. My first few months here have really been about becoming a better resource to the rest of the company. So far I like the openness to collaborate and work together.

Part of our purpose as a dental benefits provider is to “enhance lives” — can you cite an example of something you’ve worked on where you truly think we’re achieving that purpose?

Stephanie: There was a piece of legislation enacted in California in 2015 — AB 648. We supported this bill, which was brought forth by consumer groups. It establishes virtual dental homes, which is kind of like telehealth. Dental providers and hygienists can work in low-income areas, schools, Head Start programs, and clinics and are able to do initial screening and send that info to a dentist somewhere else who can view the x‑rays to evaluate. It helps people where they are. We were the only dental plan in California to support this bill and it was signed into law.

This year, we also supported another California bill, SB 379. There was already a law that says all kids in California must see a dentist before first grade. This bill lets dentists host free oral health assessments at schools because many kids who aren’t do the screenings either don’t have insurance or they’re on Medicaid and don’t have time. This bill will make it easier for kids to have this assessment before first grade.

We’d agree that your role is definitely helping in our purpose to enhance lives. 

Let’s end on a fun note. Since you two work with such complex subject matter, how would you describe your job to an eight-year-old child? 

Stephanie: Gosh, okay. I would say that I’m working to make sure more people have the chance to see a dentist and be sure their teeth are clean and free from sugar bugs. I get to meet with a lot of people and talk about really important issues … I get to go around the country trying to make it easier for people to see the dentist. What do you think of that?

Perfect. Okay, and now a different question. If you had to create your own campaign slogan, what would it be?

Devin: I’ll go with my nickname from childhood and it was Devin from Heaven. I like to think that I’m very nice, and I’ve been successful in working in legislative offices because sometimes you have to deal with people who are… not so nice. So my campaign would definitely be centered around that. I’d come in on a cloud, and there would be lots of stars and some fun music!

 

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