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Transcript of New Hampshire Insurance Department - NH.gov · Guardian Life Insurance Company 3 ... Delta Dental...
New Hampshire Insurance Department
Network Adequacy
Public Information ReleaseMarketplace Issuer Networks for the
2018 Plan Year
December 4, 2017
Agenda (Contents)
12/5/2017 Page 2
2018 Marketplace Network Information SlideNew Hampshire Marketplace Preview 3 – 6
2018 Marketplace Network & Hospital Coverage Overview 7 – 10
Substance Use Disorder Network Offerings 11 – 12
Health Insurance Carrier Network Profiles
Ambetter from NH Healthy Families, offered by Celtic Insurance 13
Anthem Blue Cross Blue Shield of New Hampshire 14 – 15
Harvard Pilgrim Health Care of New England 16
Appendix: Hospital, ECP Listings, SUD Provider Listings, and Consumer Information 17 – 30
Key Dates: 2018 Marketplace Plan Review
12/5/2017 Page 3
QH
PA
pplication Review
& C
ertification Timeline
Apr May Jun Jul Aug Sept Oct Nov Dec
Apr May Jun Jul Aug Sept Oct Nov Dec
Timeline Legend
Major Milestone
Internal Event
(11/1)- 12/15Plan Year 2018
Open Enrollment Period
(6/21)1st SERFF
Data Transfer
(June 26th and 28th)NHID to host two public
network adequacy information sessions, in compliance with RSA
420-N:5
●
(8/2)FFM Notifies
State of Corrections to QHP Data
(9/15)Final Correction
Notices and QHP Agreements
Sent to Issuers
(9/27)States Send CMS
Final Plan Recommendations
(9/16 – 9/27)Issuers Send
Signed Agreements, Confirmed Plan
Lists and Final Plan Crosswalks to CMS
(10/12)CMS Sends Countersigned Agreements & Certification Notices to Issuers
(7/3)Deadline for Rate Changes
(5/12)Issuers to submit forms and binders to NHID
(8/9)Issuer Deadline
for Revised QHP Data due
to NHID
(8/16)2nd SERFF
Data Transfer
(3/29)QHP Issuer Kickoff Meeting
●
(6/2)Issuers to submit rates to NHID
Preview of Marketplace Issuer Networks
12/5/2017 Page 4
All information provided in this presentation has been generated from insurance carrier applications and is current as of December 4, 2017.
This information does not represent final networks as they will appear on the Health Insurance Marketplace in 2018. Carriers continually negotiate contract terms with providers, and State review of these networks may result in changes to provider contracts or geographic coverage of health plans.
Hospital listings reflect only those hospitals located in NH. Essential Community Providers (ECPs) are medical care providers who serve predominantly low-income, or medically underserved patient populations as classified by CMS under 45 CFR 156.235 of the Federal Register.
Medical 2014 2015 2016 2017 2018Individual Small Group
Number of Carriers
1 Anthem BCBS
of NH
5 Anthem BCBS ME Community
Health Options Harvard Pilgrim
Health Care Minuteman
Health Assurant Health
5 Anthem BCBS ME Community
Health Options Harvard Pilgrim
Health Care Minuteman
Health Ambetter
(Celtic)
4 Anthem BCBS Harvard Pilgrim
Health Care Minuteman
Health Ambetter
(Celtic)
3 Anthem BCBS Harvard Pilgrim
Health Care Ambetter
(Celtic)
1 Anthem BCBS
Number of Plans
14 11 Individual 3 Small Group
60 42 Individual 18 Small Group
62 32 Individual 30 Small Group
49 32 Individual 19 Small Group
15 Individual
Market Plans
6 Small Group
Plans
Hospital Inclusion
16 NH acute care
hospitals in QHP networks
26 NH acute care
hospitals in QHP networks
26 NH acute care
hospitals in QHP networks
26 NH acute care
hospitals in QHP networks
26 NH acute care
hospitals in QHP networks
23 NH acute care
hospitals in QHP networks
New Hampshire Insurance Marketplace Profile:Medical Plans
12/5/2017 Page 5
New Hampshire Insurance Marketplace Profile:Dental Plans
12/5/2017 Page 6
Dental 2014 2015 2016 2017 2018Individual Small Group
Number of Carriers
3 Anthem BCBS
of NH Delta Dental Guardian Life
Insurance Company
3 Anthem BCBS Delta Dental Guardian Life
Insurance Company
4 Anthem BCBS Delta Dental Guardian Life
Insurance Company
Dentegra Insurance Company
2 Anthem BCBS Delta Dental
2 Anthem BCBS Delta Dental
1 Anthem BCBS
Number of Plans
22 11 Individual 3 Small Group
13 42 Individual 18 Small Group
15 32 Individual 30 Small Group
11 32 Individual 19 Small Group
7 Individual
Market Plans
2 Small Group
Plans
2018 Network Profile – Available Networks
12/5/2017 Page 7
Issuer Name Network Name Market Coverage
Proposed Service Area
NH HospitalsIncluded
Ambetter from NH Healthy Families, offered by Celtic
Insurance
Granite State Health Plan Individual Statewide 25
Anthem Blue Cross & Blue Shield of New
Hampshire
Pathway X Small Group Statewide 23
Pathway X Enhanced Individual Statewide 23
Harvard Pilgrim Health Care of New
England, Inc.
Harvard Pilgrim Health Care of NE
ElevateHealthIndividual
Limited to Counties: Cheshire; Coos; Grafton; Hillsborough; Merrimack; Rockingham; Strafford; Sullivan.Excludes: Belknap; Carroll.
20
2018 Network Profile – Hospital Coverage
12/5/2017 Page 8
New Hampshire boasts 26 acute care hospitals within the state’s 10 counties. New Hampshire Hospitals
2018 Network Profile Hospital Coverage – Individual Marketplace
12/5/2017 Page 9
Network Contracts per HospitalAll 26 New Hampshire acute care hospitals are included in at least 1 individual market issuer network in 2018.
2018 Network Profile Hospital Coverage – Small Group Marketplace
12/5/2017 Page 10
Network Contracts per HospitalOf the 26 New Hampshire acute care hospitals, 23 are included in the
small group market issuer network (Anthem Pathway X) in 2018.
12/5/2017 Page 11
The New Hampshire Insurance Department provided a list of providers in seven substance use disorder (SUD) treatment categories requesting that carriers indicate which providers were included in their proposed network(s).
The seven SUD treatment categories reported to NHID include: Intensive Outpatient Program Partial Hospitalization Residential Services Medication Assisted Treatment (MAT) – Buprenorphine (Suboxone) MAT – Methadone MAT – Naltrexone (Vivitrol) MAT – Other Medication
2018 Network Profile – SUD Treatment
NHID identified a total of 229 SUD providers in these categories for plan year 2018, an improvement compared to the 108 SUD providers identified for 2017.
IssuerAmbetter from NH Healthy Families, offered by Celtic
Insurance
Anthem Health Plans of NH Harvard Pilgrim
Health Care of NE
Network Name Granite State Health Plan Pathway X Pathway X
Enhanced
Harvard Pilgrim Health Care of NE
ElevateHealth
Intensive Outpatient Program 41 40 40 20MAT – Buprenorphine 20 48 48 32
MAT – Methadone 6 6 6 5MAT – Naltrexone 6 18 18 13
MAT - Other Medication 9 24 24 14Partial Hospitalization 7 7 7 5Residential Services 10 10 10 4
Total Facilities* 59 84 84 48
12/5/2017 Page 12
2018 Network Profile:SUD Treatment – Count by Issuer Network
*Facilities may provide more than one type of SUD Treatment service
Ambetter from NH Healthy Families, offered by Celtic Insurance: Granite State Health Plan-Individual
12/5/2017 Page 13
Hospitals SUD Treatment Service Area
Count: 25 Count: 59 Count: 10
Anthem Blue Cross Blue Shield of New Hampshire:Pathway X-Small Group
12/5/2017 Page 14
Hospitals SUD Treatment Service Area
Count: 23 Count: 84 Count: 10
Anthem Blue Cross Blue Shield of New Hampshire:Pathway X Enhanced and Rx Choice Tiered Network-Individual
12/5/2017 Page 15
Hospitals SUD Treatment Service Area
Count: 23 Count: 84 Count: 10
Harvard Pilgrim Health Care of New England:Elevate Health-Individual
12/5/2017 Page 16
Hospitals SUD Treatment Service Area
Count: 20 Count: 48 Count: 8
Appendix – Detailed Hospital & ECP Listings
The Insurance Department provides additional information relating to the Marketplace on its website under Federal Health Reform:
http://www.nh.gov/insurance/consumers/fedhealthref.htm
12/5/2017 Page 17
Ambetter from NH Healthy Families, offered by Celtic Insurance: Granite State Health Plan-Individual
12/5/2017 Page 18
Hospitals
Count: 25
County Hospital NameBelknap Lakes Region General Hospital
Carroll Huggins HospitalMemorial Hospital
Cheshire Cheshire Medical Center
CoosAndroscoggin Valley HospitalUpper Connecticut Valley HospitalWeeks Medical Center
Grafton
Alice Peck Day Memorial HospitalCottage HospitalLittleton Regional HealthcareMary Hitchcock Memorial HospitalSpeare Memorial Hospital
Hillsborough
Catholic Medical CenterMonadnock Community HospitalSouthern NH Medical CenterSt. Joseph Hospital
MerrimackConcord HospitalFranklin Regional HospitalNew London Hospital
RockinghamExeter HospitalParkland Medical CenterPortsmouth Regional Hospital
Strafford Frisbie Memorial HospitalWentworth-Douglass Hospital
Sullivan Valley Regional Hospital
12/5/2017 Page 19
County ECP Name County ECP NameBelknap CAP Belknap Merrimack Co. Grafton Cottage HospitalBelknap Healthfirst Family Care Center, Inc. Hillsborough Concord HospitalBelknap Lakes Region General Hospital Hillsborough MCHC –Child Health ServicesCarroll New Hampshire Department of Health & Human Services, FP Program Hillsborough Manchester Community Health CenterCarroll Saco River Medical Group Hillsborough MCHC – Greater Manchester Mental HealthCarroll CAP Belknap Merrimack Co. Hillsborough Catholic Medical Center – 177 Lake AveCarroll Huggins Hospital Hillsborough MCHC – TarrytownCheshire Cheshire Medical Center Hillsborough Catholic Medical Center – 199 Manchester StCoos New Hampshire Department of Health & Human Services, FP Program Hillsborough MCHC West Side Neighborhood Health CenterCoos Androscoggin Valley Hospital Hillsborough Lamprey Health Care, Inc.Coos Indian Stream Health Center, Inc. Hillsborough Harbor Homes, Inc.Coos Weeks Medical Center – Groveton Hillsborough Monadnock Community HospitalCoos Weeks Medical Center – Lancaster (170 Middle Street) Hillsborough Antrim Medical GroupCoos Weeks Medical Center – Lancaster (173 Middle Street) Merrimack Concord HospitalCoos Weeks Medical Center – North Stratford Merrimack Franklin Regional HospitalCoos Ammonoosuc Community Health Services Inc – Whitefield (14 King Sq) Merrimack Healthfirst Family Care Center, Inc.Coos Weeks Medical Center – Whitefield (24 Lancaster Road) Merrimack New London HospitalCoos Ammonoosuc Community Health Services – Whitefield (30 King Sq) Rockingham Families First / St. Vincent de PaulCoos Weeks Medical Center – Whitefield (8 Clover Lane) Rockingham Lamprey Health Care, Inc. - NewmarketGrafton Newfound Family Practice Rockingham Families First Health and Support CenterGrafton Ammonoosuc Community Health Services Inc – Franconia Rockingham Families First – Cross Roads HouseGrafton Mary Hitchcock Memorial Hospital Rockingham Lamprey Health Care, Inc. - RaymondGrafton Ammonoosuc Community Health Services Inc – Littleton Strafford Goodwin Community Health – Woodman Park ESGrafton Littleton Regional Healthcare Strafford Goodwin Community Health – Horne Street ESGrafton Speare Primary Care Strafford Goodwin Community Health – Somersworth Grafton Speare Memorial Hospital Sullivan Springfield Medical Care Systems, Inc.Grafton Dartmouth-Hitchcock Clinic Sullivan Valley Regional HospitalGrafton Ammonoosuc Community Health Services – Warren Sullivan Newport Health CenterGrafton Ammonoosuc Community Health Services Inc – Woodsville
Ambetter from NH Healthy Families, offered by Celtic Insurance: Granite State Health Plan-Individual
Anthem Blue Cross Blue Shield of New Hampshire:Pathway X- Small Group
12/5/2017 Page 20
Hospitals
Count: 23
County Hospital NameBelknap Lakes Region General Hospital
Carroll Huggins HospitalMemorial Hospital
Cheshire Cheshire Medical Center
CoosAndroscoggin Valley HospitalUpper Connecticut Valley HospitalWeeks Medical Center
Grafton
Alice Peck Day Memorial HospitalCottage HospitalLittleton Regional HealthcareMary Hitchcock Memorial HospitalSpeare Memorial Hospital
Hillsborough
Catholic Medical CenterElliot HospitalMonadnock Community HospitalSouthern NH Medical CenterSt. Joseph Hospital
Merrimack Franklin Regional HospitalNew London Hospital
Rockingham Exeter Hospital
Strafford Frisbie Memorial HospitalWentworth-Douglass Hospital
Sullivan Valley Regional Hospital
Anthem Blue Cross Blue Shield of New Hampshire:Pathway X and Rx Choice Tiered Network-Individual
12/5/2017 Page 21
Hospitals
Count: 23
County Hospital NameBelknap Lakes Region General Hospital
Carroll Huggins HospitalMemorial Hospital
Cheshire Cheshire Medical Center
CoosAndroscoggin Valley HospitalUpper Connecticut Valley HospitalWeeks Medical Center
Grafton
Alice Peck Day Memorial HospitalCottage HospitalLittleton Regional HealthcareMary Hitchcock Memorial HospitalSpeare Memorial Hospital
Hillsborough
Catholic Medical CenterElliot HospitalMonadnock Community HospitalSouthern NH Medical CenterSt. Joseph Hospital
Merrimack Franklin Regional HospitalNew London Hospital
Rockingham Exeter Hospital
Strafford Frisbie Memorial HospitalWentworth-Douglass Hospital
Sullivan Valley Regional Hospital
Anthem Blue Cross Blue Shield of New Hampshire:Pathway X and Rx Choice Tiered Network-Small Group & Individual
12/5/2017 Page 22
County ECP Name County ECP NameBelknap CAP Belknap Merrimack Co. Grafton Speare Primary CareBelknap Healthfirst Family Care Center, Inc. Grafton Speare Memorial HospitalBelknap Lakes Region General Hospital Grafton Dartmouth-Hitchcock ClinicCarroll New Hampshire Department of Health & Human Services, FP Program Grafton Ammonoosuc Community Health Services - WoodsvilleCarroll Saco River Medical Group Grafton Cottage HospitalCarroll Memorial Hospital, The Hillsborough Antrim Medical GroupCarroll CAP Belknap Merrimack Co. Hillsborough Concord HospitalCarroll Huggins Hospital Hillsborough MCHC – Child Health ServicesCheshire Cheshire Medical Center Hillsborough Manchester Community Health CenterCoos Coos County Family Health Services – Pleasant Street Clinic Hillsborough Catholic Medical Center (177 Lake Ave)Coos Androscoggin Valley Hospital Hillsborough MCHC – TarrytownCoos Coos County Family Health Services, Inc. – Page Hill Clinic Hillsborough Catholic Medical Center (199 Manchester St)Coos Indian Stream Health Center, Inc. Hillsborough Planned Parenthood of Northern New EnglandCoos Upper Connecticut Valley Hospital Hillsborough MCHC West Side Neighborhood Health CenterCoos Coos County Family Health Services, Inc. – Gorham Clinic Hillsborough Lamprey Health Care, Inc.Coos Weeks Medical Center – Groveton Hillsborough Harbor Homes, Inc.Coos Weeks Medical Center – Lancaster (170 Middle St) Hillsborough Monadnock Community HospitalCoos Weeks Medical Center – Lancaster (173 Middle St) Merrimack Concord HospitalCoos Weeks Medical Center – North Stratford Merrimack Franklin Regional HospitalCoos Ammonoosuc Community Health Services Inc Merrimack Healthfirst Family Care Center, Inc.Coos Weeks Medical Center Merrimack New London HospitalGrafton Ammonoosuc Community Health Services Inc – Littleton Rockingham Families First Health and Support CenterGrafton Mid-state Health Center Rockingham Lamprey Health Care, Inc. - NewmarketGrafton Newfound Family Practice Rockingham Families First – Cross Roads HouseGrafton Ammonoosuc Community Health Services Inc – Franconia Rockingham Lamprey Health Care, Inc. - RaymondGrafton Mary Hitchcock Memorial Hospital Strafford Goodwin Community HealthGrafton Alice Peck Day Memorial Hospital Sullivan Springfield Medical Care Systems, Inc.Grafton Littleton Regional Healthcare Sullivan Valley Regional HospitalGrafton Mid-state Health Center Sullivan Newport Health Center
Harvard Pilgrim Health Care of New England:Elevate Health-Individual
12/5/2017 Page 23
Hospitals
Count: 20
County Hospital NameBelknap Lakes Region General HospitalCheshire Cheshire Medical Center
CoosAndroscoggin Valley HospitalUpper Connecticut Valley HospitalWeeks Medical Center
Grafton
Alice Peck Day Memorial HospitalCottage HospitalLittleton Regional HealthcareMary Hitchcock Memorial Hospital
Hillsborough
Elliot HospitalMonadnock Community HospitalSouthern NH Medical CenterSt. Joseph Hospital
MerrimackConcord HospitalFranklin Regional HospitalNew London Hospital
Rockingham Exeter Hospital
Strafford Frisbie Memorial HospitalWentworth-Douglass Hospital
Sullivan Valley Regional Hospital
Harvard Pilgrim Health Care of New England:New Hampshire Network-Individual
12/5/2017 Page 24
County ECP Name County ECP NameBelknap Healthfirst Family Care Center, Inc. Grafton Ammonoosuc Community Health Services - LittletonBelknap Lakes Region General Hospital Grafton Ammonoosuc Community Health Services - WoodsvilleCarroll New Hampshire Department of Health & Human Services, FP Program Grafton Cottage HospitalCarroll Saco River Medical Group Hillsborough Antrim Medical GroupCarroll Memorial Hospital, The Hillsborough Concord HospitalCarroll Huggins Hospital Hillsborough Manchester, City OfCheshire Cheshire Medical Center Hillsborough MCHC – Child Health ServicesCoos Coos County Family Health Services – Pleasant Street Clinic Hillsborough Manchester Community Health CenterCoos New Hampshire Department of Health & Human Services, FP Program Hillsborough MCHC – Greater Manchester Mental HealthCoos Androscoggin Valley Hospital Hillsborough Catholic Medical Center – 177 Lake AveCoos Coos County Family Health Services, Inc. – Page Hill Clinic Hillsborough MCHC – TarrytownCoos Indian Stream Health Center, Inc. Hillsborough Catholic Medical Center – 199 Manchester StCoos Upper Connecticut Valley Hospital Hillsborough Planned Parenthood of Northern New EnglandCoos Coos County Family Health Services, Inc. – Gorham Clinic Hillsborough MCHC West Side Neighborhood Health CenterCoos Weeks Medical Center – Groveton Hillsborough Harbor Homes, Inc. – St. Joseph’s HospitalCoos Weeks Medical Center – Lancaster (170 Middle St) Hillsborough Lamprey Health Care, Inc.Coos Weeks Medical Center – Lancaster (173 Middle St) Hillsborough Harbor Care Health and Wellness CenterCoos Weeks Medical Center – North Stratford Hillsborough Monadnock Community HospitalCoos Ammonoosuc Community Health Services Inc – Whitefield (14 King Sq) Merrimack Concord HospitalCoos Weeks Medical Center – Whitefield (24 Lancaster Rd) Merrimack Franklin Regional HospitalCoos Ammonoosuc Community Health Services – Whitefield (30 King Sq) Merrimack healthfirst family care center, inc.Coos Weeks Medical Center – Whitefield (8 Clover Lane) Merrimack New London HospitalGrafton Mid-state Health Center - Bristol Rockingham Families First – St. Vincent de PaulGrafton Newfound Family Practice Rockingham Lamprey Health Care, Inc. – NewmarketGrafton Ammonoosuc Community Health Services Inc – Warren Rockingham Families First – Cross Roads HouseGrafton Mary Hitchcock Memorial Hospital Rockingham Families First Health and Support CenterGrafton Alice Peck Day Memorial Hospital Rockingham Lamprey Health Care, Inc. – RaymondGrafton Ammonoosuc Community Health Services Inc - Franconia Strafford Goodwin Community Health – Woodman Park ESGrafton Littleton Regional Healthcare Strafford Goodwin Community Health – Horne Street ESGrafton Mid-state Health Center - Plymouth Strafford Goodwin Community Health – Somersworth Grafton Speare Primary Care Sullivan Springfield Medical Care Systems, Inc.Grafton Speare Memorial Hospital Sullivan Valley Regional HospitalGrafton Dartmouth-Hitchcock Clinic Sullivan Newport Health Center
Harvard Pilgrim Health Care of New England:Elevate Health-Individual
12/5/2017 Page 25
County ECP Name County ECP NameCheshire Cheshire Medical Center Hillsborough Planned Parenthood of Northern New EnglandCoos Coos County Family Health Services – Pleasant Street Clinic Hillsborough Lamprey Health Care, Inc.Coos New Hampshire Department of Health & Human Services, FP Program Hillsborough Monadnock Community HospitalCoos Androscoggin Valley Hospital Merrimack Concord HospitalCoos Coos County Family Health Services, Inc. – Page Hill Clinic Merrimack New London HospitalCoos Indian Stream Health Center, Inc. Rockingham Lamprey Health Care, Inc.Coos Upper Connecticut Valley Hospital Rockingham Lamprey Health Care, Inc.Coos Coos County Family Health Services, Inc. – Gorham Clinic Strafford Goodwin Community Health – Woodman Park ESCoos Weeks Medical Center – Groveton Strafford Goodwin Community Health – Horne Street ESCoos Weeks Medical Center – Lancaster (170 Middle St) Strafford Goodwin Community Health – Somersworth Coos Weeks Medical Center – Lancaster (173 Middle St) Sullivan Valley Regional HospitalCoos Weeks Medical Center – North Stratford Sullivan Newport Health CenterCoos Ammonoosuc Community Health Services Inc – Whitefield (14 King Sq)Coos Weeks Medical Center – Whitefield (24 Lancaster Rd)Coos Ammonoosuc Community Health Services – Whitefield (30 King S1)Coos Weeks Medical Center – Whitefield (8 Clover Lane)Grafton Ammonoosuc Community Health Services Inc – WarrenGrafton Mary Hitchcock Memorial HospitalGrafton Alice Peck Day Memorial HospitalGrafton Ammonoosuc Community Health Services Inc - FranconiaGrafton Dartmouth-Hitchcock ClinicGrafton Ammonoosuc Community Health Services - LittletonGrafton Ammonoosuc Community Health Services Inc - WoodsvilleGrafton Cottage HospitalHillsborough Antrim Medical GroupHillsborough Concord HospitalHillsborough MCHC – Greater Manchester Mental Health
SUD Provider Details
12/5/2017 Page 26
The New Hampshire Insurance Department will posted the detailed list of SUD facilities within each issuer’s network to the Insurance Department website.
NHID also encourages all individuals exploring treatment options to explore the list of SUD providers located at: http://nhtreatment.org/
Consumer Notice Requirements
12/5/2017 Page 27
The Department carefully monitors changes in the issuers provider networks and has issued guidance on network changes that trigger consumer notifications.
QHP issuers must not only notify the Department, but also send notice to consumers in the event of:
• Addition or removal of a benefit from a plan (for example-pediatric dental benefits)
• The loss of a major inpatient or outpatient facility or large provider group • This consumer disclosure must appear on the first page of the notice in bold
type and include the name of the hospital.
• The elimination of a network or service area reduction.
Consumers should contact their health insurance carrier if they receive a notification regarding a network change and need more information about the impact.
Provider Network Directory Requirements
12/5/2017 Page 28
In accordance with both state and federal guidance issuers are to have provider directory specific to each plan, including those with multiple networks.
QHP issuers, including SADPs, must publish:• An up-to-date, accurate, and complete provider directory, refreshed at least every
30 days;• Information on which providers are accepting new patients, the provider’s location,
contact information, specialty, medical group, and any institutional affiliations;• In a manner that is easily accessible-meaning that the general public can access
the information without having to use a policy number or create an account.
The Department reviews provider directories prior to open enrollment to ensure compliance with the above standards.
Consumers are urged to contact the NHID Consumer Service Division at 603-271-2261 or email [email protected] if they have concerns about an issuer’s provider directory.
Formulary Requirements
12/5/2017 Page 29
In accordance with both state and federal guidance issuers must have a formulary clearly identifiable to each plan, including those with multiple networks.
QHP issuers must publish a formulary drug list that is:• Easily accessible and can be viewed on the plan’s public website through a clearly
identifiable link or tab without requiring an individual to create or access an account or enter a policy number;
• In a format that an individual can easily discern which formulary drug list applies to which plan;
• Publicly available on their websites in a machine-readable file and format specified by CMS, to allow the creation of user-friendly aggregated information sources.
The Department reviews formulary requirements prior to open enrollment to ensure compliance with the above standards. For 2018, the Department has also requested the full formulary from issuers in the initial filings in a PDF format so that the Department can review.
Thank You
Contact Information
New Hampshire Insurance Department21 South Fruit Street, Suite #14Concord, NH [email protected]: (603) 271-2261Fax: (603) 271-1406TTY/TDD: 1 (800) 735-2964
www.nh.gov/insurance
12/5/2017 Page 30