REG- j20399-/% Page 1 of 1
JUL 7 2010

LEGAL PROCESSING DIVISION
PUBLICATION & REGULATIONS
BRANCH As of: July 07, 2010

PUBLIC peg tt at
Posted: July 07,
SUBMISSION Comments Due: August 27, 2010

Submission Type: Web

Docket: IRS-2010-0015
Requirements for Group Health Plans and Health Insurance Issuers under the Patient Protection
and Affordable Care Act

Comment On: IRS-2010-0015-0002
Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Arnual
Limits, Rescissions, and PatientProtections

Document: IRS-2010-0015-0005
Comment on FR Doc # 2010-15278

Submitter Information

Name: Victoria L Veltri
Address:
P.O. Box 1543
Hartford, CT, 06144
Email: victoria.veltri@ct.gov
Phone: 860-297-3982
Fax: 860-297-3992
Submitter's Representative: Victoria Veltri
Organization: State of CT Office of the Healthcare Advocate
Government Agency Type: State
Government Agency: State of CT Office of the Healthcare Advocate

General Comment

See attached comments.

Attachments

IRS-2010-0015-0005.1: Comment on FR Doc # 2010-15278

https://fdms.erulemaking .net/fdms-web-agency/component/submitterInfoCoverPage?Call=P... 7/7/2010


“ _ | OFFICE OF THE

HEALTHCARE ADVOCATE
@)
7
ro

STATE OF CONNECTICUT

July 1, 2010

Office of Consumer Information and Insurance Oversight
Department of Health and Human Services,

Attention: OCIIO-9994-IFC,

P.O. Box 8016,

Baltimore, MD 21244-1850

Re: Response to Request for Comments, OCIIO-9994-IFC
To Whom it May Concern:

The State of Connecticut Office of the Healthcare Advocate (“OHA”) offers its
comments on the above-captioned OCIIO-9994-IFC request for comments related to
Section 1001 of the Patient Protection and Affordable Care Act of 2010 (“PPACA”),
Public Law 111-148 (effective March 23, 2010), which creates section 2712 of the Public
Health Service Act (“PHSA”) and section 2301 of the Health Care and Education
Reconciliation Act of 2010 (“HCERA”), Public Law 111-152, which makes Section 2712 of
the PHSA applicable to grandfathered plans. OHA believes that the setting, definition
and enforcement of a rigorous process to guard against abusive rescission practices at
the federal level is critical to reigning in the unwarranted consumer abuses in the
marketplace. Our comments reflect our concern that section 2712 is interpreted in the
manner in which it was proposed, to protect consumers.

We are grateful that section 2712 sets a federal floor that will allow states to
enact even stronger protections for consumers. We wish its interpretation to be
accorded the weight it deserves, given the considerable attention that rescission issues
received from Congress over the last several years.

Comments on the Interim-Final Rule

We have several comments with respect to the interim-final rule on PHSA
section 2712. Those comments are as follows.


1. For the benefit of beneficiaries, the word "material" in reference to a “material fact”
should be defined.
¢ Beneficiaries should know what kind of information is “material” to the
issuance of an insurance policy.
2. The notice to the insured should contain specific information on how the insured can
access all the information the insurer relied on to make a determination to rescind.
¢ This will make the process fairer for consumers and will allow for better
preparation for an appeal.
3. The notice from the insurer should note that insurer bears the burden of proving
intentional misrepresentation or fraud.
e  Rescission is such a drastic remedy that it should be the burden of the
insured to prove intentional misrepresentation of a material fact or fraucl.
4. Notice should explain other relief available if the insurer doesn't reverse its decision.
e The notice should explain whether further review with the company, an
external reviewer, or a court may be available.

Generally, OHA believes that requiring insurers to use a third-party review process
would make the process fairer for consumers and would reach the true goal of the
provision, to prevent unwarranted rescissions. Providing advanced notice to an enrollee
before rescinding is a positive step, but it still puts the decision to rescind in the hands
of the insurer, without an apparent right to further review---except in court.

Thank you for your consideration of OHA’s comments. You may direct any
questions concerning these comments to me at victoria.veltri@ct.gov or at (860)297-
3982.

Very truly yours,

bse

Victoria L.Veltri
General Counsel

(od Kevin Lembo, Healthcare Advocate

P.O. Bos 1543 ¢ Harttord, CU OGLE © 1 S66LIMO-H6 * www.ctgov/oha

NOW YOULL BE HEARD