A new report by the National Association of Insurance Commissioners’ Consumer Representatives calls for regulatory oversight to ensure insurers comply with the Affordable Care Act requirement to cover certain preventive services without cost-sharing. The authors reviewed how six individual market plans in different jurisdictions complied with a sample of four services health plans must cover without cost sharing and found that “the ways that insurers organize and expose information to providers and consumers is a meaningful barrier to effective understanding and use of preventive service benefits.”  

The report recommends that state regulators analyze claims adjudication processes and assess drug formularies to understand whether plans are abiding by coverage and cost-sharing requirements; work with plans to ensure simple and transparent appeals processes for cost-sharing violations; hold plans accountable for educating consumers and providers; and promote uniform billing and coding guidance for use across plans.

In light of a recent federal lawsuit challenging the ACA requirement that most health plans cover certain preventive services without cost sharing, the report also recommends commissioners secure voluntary commitments from plans in their states to ensure continued access to these services without cost sharing, and monitor and enforce transparency and notice provisions for any plan design change.

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