Principles for Exchanges
Cigna supports the development of a health insurance exchange marketplace that facilitates access to high quality and cost effective care. At Cigna, we believe:
Exchanges should ensure a level playing field and supplement, but not replace, existing markets.
- Current markets should continue to operate.
- Carriers should not be required to sell all “metal” plans outside the exchanges.
- Exchanges should not be the only place to buy individual and small group plans.
Exchanges should promote an efficient regulatory environment by leaving insurance regulation to the existing state regulatory body.
- Rate review and other regulatory functions should remain at the Department of Insurance or existing regulatory body.
- Exchanges should not impose additional licensure requirements beyond those currently required by the state.
Exchanges should promote competition by having consistent and objective participation criteria for health plans.
- Carriers that meet the qualified health plans requirements should be allowed to participate in the exchanges without undergoing a competitive bidding process.
- Exchanges should not set premium or establish health care professional reimbursement rates.
Exchanges should ensure meaningful choices for consumers.
- Carriers should have flexibility in product, cost-sharing and network design.
- Carriers should be allowed to choose the markets in which they participate.
Systems should be established that ensure increased participation, mitigate risk selection both inside and outside of the exchange market, and minimize disruption to employers.
- Individual and small group markets should be administered separately under a single state exchange.
- Risk adjustment tools should use best practices and ensure that carriers can continue to innovate through benefit design.
- Large group employers should not be required to participate in the exchanges.
Exchanges should promote quality and improved health outcomes.
- Carriers should be required to report on activities, such as care/disease management, treatment compliance and wellness and health promotion programs.
There should be uniform standards for data elements so consumers have access to useful, accurate and understandable information.
- Health and Human Services (HHS) should support the adoption and utilization of standard data transmission (e.g., HIPAA transaction standards), terminology, benefit descriptions and eligibility transmission to promote consistency across states and to reduce administrative costs.
Exchanges should incorporate seamless coordination with public programs.
- Exchanges should be allowed to contract with private companies to perform certain functions, such as eligibility determination.
Exchanges should establish a transparent governance model that includes representation of consumers, employers, health care professionals and individuals with actuarial and insurance expertise.
- Exchanges should adopt state open records and meetings policies.
- Exchanges should be established as a non-profit or trust and should be funded through a broad funding source.