On January 27, 2021, the Division of Insurance issued Bulletin 21-02, announcing that the division will allow insurers the option to renew non-ACA-compliant individual and small group coverage if coverage has been continuously in effect since December 31, 2013. Policies may continue to be renewed on or before October 1, 2022, provided that all such coverage comes into compliance with the specified requirements by January 1, 2023. Insurers may early renew coverage or issue coverage for periods less than one year if a policy terminates prior to December 31, 2022.

On January 19, 2021, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Alaska and allows the issuer to renew these non-ACA compliant plans.

Insurers who renew non-ACA compliant policies must provide enrollees with notice concerning how their premiums may be affected by this decision.

Employers with plans regulated by the state should be aware of this development.

Bulletin 21-02 »

On January 15, 2021, Director Wing-Heier issued orders R21-01, R21-02, R21-03 and R21-04. These emergency measures were issued following the governor’s extension of his public health disaster emergency order regarding COVID-19.

R21-01 requires insurers to waive any cost sharing for laboratory diagnostic testing for respiratory syncytial virus, influenza and COVID-19. It also requires insurers to cover telehealth service categories no less generously than required by Medicare under the national public health emergency as long the public health emergency is in effect. It requires insurers to allow early refills or replacements of lost or damaged medications and expects this flexibility to continue for the duration of the public health disaster emergency. Insurers are required to allow affected consumers to obtain emergency supplies or refills without applying additional authorization requirements. In addition, consumers must be able to access their necessary prescriptions from a local retail pharmacy even if their prescription supply is normally provided by mail order without concern of a penalty. These requirements do not apply to prescriptions containing opioids. Finally, insurers are required to suspend any contract prohibition of family members providing covered home healthcare services during the public health emergency disaster.

R21-02 requires insurers to allow employers to continue covering employees under group policies even if the employee would otherwise become ineligible due to a decrease in hours worked per week. Insurers shall allow employers to continue providing coverage to employees under group policies regardless of any “actively at work” or similar eligibility requirement in the policy. Additionally, insurers are not allowed to increase premium rates or terminate a group policy based on a group’s decreased enrollment or participation due to COVID-19 during a plan year.

R21-03 requires insurers to cover infusion therapies intended to treat COVID-19, cover the vaccine administration at zero cost sharing, and recognize any provider offering the vaccine consistent with a state vaccination program.

R21-04 requires insurers to waive any requirements for location-based credentialing and pay claims for covered services when consumers are billed for services located at, sponsored by or facilitated by the local, state or federal government during this pandemic until such alternate sites are closed.

The orders are effective on January 15, 2021, and expire on February 14, 2021, or until the governor declares that the public health emergency is over.

Employers with plans regulated by the state should be aware of these orders.

R21-01 »
R21-02 »
R21-03 »
R21-04 »

On October 2, 2020, the Division of Insurance issued Bulletin 20-18, reminding healthcare insurers in Alaska that they are required to expand telehealth coverage to all covered services of healthcare insurance plans in group markets subject to state law. Services must be provided by a healthcare provider licensed in Alaska. A prior in-person visit must not be required. Insurers cannot mislead consumers or providers concerning mandated services and failing to provide this service is a violation of state law. The insurer must also offer non-network options to those it covers, including access to telehealth services, and state law does not limit the location of telehealth services. Finally, the services must be HIPAA-compliant.

Employers with plans regulated by the state should be aware of this development.

Bulletin 20-18 »

On March 27, 2019, the Alaska Division of Insurance published Bulletin 19-05. The bulletin provides another one-year extension to the transitional policy of non-ACA-compliant individual and small group policies and plans issued in Alaska.

As background, on March, 25, 2019, CMS issued guidance allowing extensions of so-called “grand mothered policies” (for example, non-ACA-compliant plans that have been continued since 2013), subject to state and carrier approval. Bulletin 19-05 represents Alaska’s approval for such extension.

Bulletin 19-05 states that insurers have the option to renew non-ACA-compliant policies if coverage has been continuously in effect since December 31, 2013. Those policies may continue to be renewed on or before October 1, 2020, provided the policy will terminate by December 31, 2020. Insurers may early renew or issue coverage for periods less than one year if a policy terminates prior to December 31, 2020, and, in the case of a small group, if the employer wants coverage through the end of the calendar year.

The bulletin presents two options for insurers that elect to extend non-ACA policies. Under the first option, an insurer may permit employer-sponsored groups currently enrolled in the insurer’s non-ACA-compliant plan to continue to renew their coverage. Under the second option, the insurer may provide an additional opportunity to renew coverage in its non-ACA-compliant plan to an employer-sponsored group that’s currently enrolled in the insurer’s non-ACA-compliant plan but has indicated its intent to not renew at the end of the plan year.

Alaska small employers that are interested in renewing a non-ACA-compliant plan should work with their advisors and insurers.

Bulletin 19-05 »

On Jan. 30, 2019, Director Wing-Heier issued Bulletin B 19-02 to provide information to insurers and entities regarding association health plans (AHPs) and the application of AK’s insurance statutes.

As background, the DOL and EBSA published a final rule relating to AHPs on June 21, 2018, intending to expand access to AHP coverage options. The final rule establishes new standards and criteria for the creation of AHPs and, by providing additional clarifications of existing criteria, expands access to health coverage through AHPs. Specifically, the new regulatory framework expands the “commonality of interest” requirement to include geographic location and industry. The expansion is intended to allow employers from non-related industries and trades from the same geographical areas and working owners (for example, sole proprietors with no employees) to access health coverage through AHPs. This AK bulletin points out that several provisions of the final rule are in direct conflict with existing AK statutes, and while AK seeks to harmonize any conflicts to the reasonable benefit and flexibility to AK employers, the new final rules do not preempt state law.

Because AK continues to have broad authority under ERISA to regulate AHPs under state licensure and solvency statutes, insurance companies that offer health insurance plans to AHPs in AK must follow the existing state regulations. Regarding self-funded AHPs, any entity wishing to form a self-funded AHP in AK must do so within the existing framework of permissible self-funded arrangements. Specifically, AK requires employers in an AHP to be members of a “bona fide association or group of two or more businesses in the same or a closely related trade, profession or industry that provide support, services, or supplies primarily to that trade, profession or industry.” So, the expansion of “commonality of interest” within the DOL’s final rules is not permissible in AK. Also keep in mind that all AHPs, both fully-insured and self-funded, must file with the Division of Insurance for review.

AK employers interested in AHPs should work closely with insurance carriers on fully-insured arrangements. However, the provisions of the DOL’s final rule intended to expand access will likely not be permissible for self-funded AHPs under existing AK regulations.

Bulletin B 19-02 »

On April 12, 2018, the Alaska Division of Insurance published Bulletin 18-07. The bulletin relates to another one-year extension to the transitional policy of non-ACA-compliant individual and small group policies and plans.

As background, on April 9, 2018, CMS issued guidance allowing extension of so-called “grandmothered policies” (i.e., non-ACA-compliant plans that have been continued since 2013), subject to state and carrier approval. Bulletin 18-07 represents Alaska’s approval for such extension.

Bulletin 18-07 states that insurers have the option to renew non-ACA-compliant policies if coverage has been continuously in effect since Dec. 31, 2013. Those policies may continue to be renewed on or before Oct. 1, 2019, provided the policy will terminate by Dec. 31, 2019. Insurers may early renew or issue coverage for periods less than one year if a policy terminates prior to Dec. 31, 2019 and, in the case of a small group, if the employer wants coverage through the end of the calendar year.

The bulletin presents two options for insurers that elect to extend non-ACA policies. Under the first option, an insurer may permit employer-sponsored groups currently enrolled in the insurer’s non-ACA-compliant plan to continue to renew their coverage. Under the second option, the insurer may provide an additional opportunity to renew coverage in its non-ACA-compliant plan to an employer-sponsored group that’s currently enrolled in the insurer’s non-ACA-compliant plan but has indicated its intent to not renew at the end of the plan year.

Alaska small employers that are interested in renewing a non-ACA-compliant plan should work with their advisors and insurers.

Bulletin 18-07 »

On July 7, 2017, HHS approved Alaska’s application for a state innovation waiver under Section 1332 of the ACA. As background, the ACA allows states to apply for a waiver from certain ACA requirements, so long as the state meets certain requirements (including the state showing that their own innovative ideas and strategies will result in more individuals receiving coverage). Alaska’s application sought to implement the Alaska Reinsurance Program (ARP) for 2018 and beyond. The ARP is a state-operated reinsurance program that covers claims in the individual market for individuals with one or more of 33 identified high-cost conditions. The ARP is meant to stabilize premiums and increase coverage in the individual market. Because the ARP will lower premiums, the second-lowest-cost silver plan premium is reduced, which means the federal government will spend less on premium tax credits (PTCs) for individuals in Alaska. As a result, Alaska will receive pass-through funding based on the amount of PTCs that would have been provided to individuals absent the waiver. This does not mean the individual mandate is no longer applicable in Alaska, or that individuals cannot continue to receive PTCs in Alaska. Rather, the federal government will send additional funds to Alaska to help fund the ARP.

The HHS approval is effective for Jan. 1, 2018, through Dec. 31, 2022. HHS also released a fact sheet with additional information on the Alaska waiver approval.

The HHS approval contains no new employer obligations. But employers may have heard the news about a waiver, so understanding the approval and its consequences in the individual market is helpful.

HHS Approval »

Fact Sheet »

On July 20, 2016, Gov. Walker signed HB 372 into law, which provides updates to coverage requirements for services provided by primary care providers (PCPs), obstetricians and gynecologists (OB-GYNs) and pediatricians. On PCPs and pediatricians, plans that provide coverage through networks of providers must allow plan participants to access out-of-network providers. Such plans may require higher copayments, deductibles or premiums for out-of-network providers. Also, if a plan requires participants to designate a PCP, participants may choose any available PCP (which, effective Oct. 16, 2016, includes a pediatrician) to receive appropriate specialty care. On OB-GYNs, effective Oct. 16, 2016, plans that provide coverage for OB-GYN services and require participants to select a PCP must allow female participants to receive OB-GYN care from participating providers that specialize in OB-GYN services without requiring prior authorization or referrals. Employers with fully insured plans in Alaska should be aware of the new law and requirements.

HB 372 »

On July 11, 2016, Gov. Walker signed SB 53 into law. The new law contains two separate requirements for fully insured plans in Alaska. The first requirement relates to coverage for autism spectrum disorder. Under current law, coverage must include treatment prescribed by a licensed physician or psychologist. Under the new law, that list includes treatment prescribed by an advanced practice registered nurse practitioner. The second requirement relates to coverage of services provided by midwives. Specifically, under the new law, plans that provide coverage for services performed for women during pregnancy and childbirth (and for a period of time following childbirth) must provide coverage for the same services performed by advanced practice registered nurses, so long as the services performed are within the practice scope of certified midwives (also sometimes referred to as ‘certified nurse midwives’). The law is effective July 7, 2016. Overall, the law adds no new employer compliance obligations, but employers with fully insured plans in Alaska should be aware of the changes.

SB 53 »

On July 11, 2016, Gov. Walker signed SB 142 into law. The new law relates to coverage for certain anti-cancer treatment for fully insured plans in Alaska. Under the new law, plans that provide coverage for anti-cancer medications that are injected or administered intravenously by a health care provider and such medications administered directly by the plan participant (such as orally administered or self-injected medications) cannot apply higher cost-sharing (including co-insurance, co-payments or deductibles) than the plan applies to injected or intravenously anti-cancer medications. This is the case regardless of the plan’s formulations or benefit category design or determination. For purposes of the new law, “anti-cancer medications” include drugs or biologics used to kill, slow or prevent the growth of cancerous cells or to treat related side effects. The new law is effective for plans beginning (or renewed) on or after Jan. 1, 2017. The law includes no new employer compliance obligations, but employers with fully insured plans in Alaska should be aware of it.

SB 142 »