Insurers fret over potential IT problems for enrollment

Health plan officials are pressing the CMS to affirmatively notify them when their members choose a different plan through HealthCare.gov for 2015 rather than re-enrolling in the same plan. But the CMS merely says it is exploring whether it will accommodate that request.

The CMS has announced that consumers who bought a 2014 exchange plan will, if they take no action, be automatically re-enrolled in the same plan for 2015. But insurance industry officials worry that consumers who select a different plan during the coming open enrollment might not be automatically dis-enrolled from their old plan. That creates the potential of a consumer being double-charged on premiums, which one plan official called “a customer service nightmare.”

A CMS spokesman said the agency has designed the re-enrollment process so that HealthCare.gov will send an enrollment transaction to insurers for everyone who should be re-enrolled, the spokesman said. “Issuers who do not receive a transaction for a member can safely let their policy end.”

But an insurance company representative who did not want to be named said insurers would prefer to get an affirmative notification of members’ termination to avoid any mix-ups.

The agency already sends out such termination notices when a consumer switches plans midyear because of a change in life circumstances. That leaves open the question as to why the agency cannot send such termination transactions to address insurer concerns.

When asked, the CMS spokesman said the agency is “exploring the extent” to which it can send such transactions.

There’s also anxiety about the new enrollee login system. Exchange officials scrapped the old login system, called EIDM, and replaced it with a new one. Observers hope it will provide a smoother, more intuitive experience for consumers.

But the replacement login system is in testing and won’t be broadly available for inspection by the insurance community until October. Open enrollment starts Nov. 15.

“If there are glitches, there’s not a cushion,” said Ferris Taylor, chief strategy officer at Arches Health Plan, a consumer-governed co-op insurance in Utah.

Dan Schuyler, the senior director of exchange technology for Leavitt Partners, predicted HealthCare.gov’s customer experience will be better for 2015 than it was for 2014, arguing that the cloud technology provided by Amazon Web Services will make a difference.

But, he cautioned, the customer traffic may be so heavy that site performance will still slow down.