Submitted via the Federal erulemaking Portal:

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1 June 4, 2010 Submitted via the Federal erulemaking Portal: U.S. Department of Health and Human Services Office of the Secretary Attention: DHHS-9997-IFC Hubert H. Humphrey Building, Room 455-G 200 Independence Avenue, SW Washington, DC Re: Health Care Reform Insurance Web Portal Requirements Response to Interim Final Rule and Request for Comment Regarding Section 1103 of the Patient Protection and Affordable Care Act Dear Sir or Madam: Aetna welcomes the opportunity to respond to the Department of Health and Human Services' (the "Department's") Interim Final Rule with comment period regarding the Health Care Reform Insurance Web Portal Requirements of the Patient Protection and Affordable Care Act ("PPACA"), as published in the May 5, 2010 Federal Register (75 Fed. Reg ) (the "Rule"). Aetna is one of the nation's leading diversified health care benefits companies, providing members with information and resources to help them make better informed decisions about their health care. Our programs and services strive to improve the quality of health care while controlling rising health benefit costs. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans and medical management capabilities. As a key stakeholder affected by PPACA, Aetna is committed to working with the Department in developing reasonable administrative standards in PPACA's implementation, including the web portal. In our view, the portal serves a transitional purpose, which is to provide consumers with access to consumer-friendly, actionable information about available health insurance options until 2014, when the state portals and American Health Benefit Exchanges ("Exchanges") are operational and serve as the primary marketplaces for consumers. Today, there are a number of successful, consumer-focused models for this type of portal, both within the insurance industry (e.g., ehealth.com, esurance.com), and in other markets (e.g., amazon.com). The experience from these examples suggests that a portal can have the greatest impact if: It provides effective initial navigation for the user to understand and access those insurance options best suited to their needs; 1

2 It presents those insurance options in a consumer-friendly manner, with only the information necessary to help the consumer select among those choices; and It connects directly to the associated vendor's website for details, pricing and purchasing of health insurance coverage, rather than attempting to replicate those functions within the portal itself. All health insurers maintain direct web-based information and purchasing capabilities today and additionally there are other market portals available in selected locations, e.g., the Massachusetts Connector. We believe that the federal portal can have the greatest impact by linking to and leveraging these capabilities, and that this approach would also minimize required build time and be cost-effective for the government and for health insurers. This approach would also eliminate potential market confusion for the consumer. This thought underlies the general and specific comments Aetna offers for the Department's consideration on the purpose of the web portal and scope of the Rule. I. General Comment on the Role of the Web Portal and the Scope of the Rule Recommendation: We recommend that the web portal contemplated under the Rule be re-scaled, consistent with legislative intent, in order to reduce complexity of implementation, much of which may not have value for the consumer. The result would be to provide consumers with an effective marketplace to shop for available health insurance until 2014 when state portals and Exchanges are in place. The web portal should provide information on federal programs, general types of coverage offered by insurers within a state, and links to insurers' websites for more detailed coverage and pricing information: this design will avoid confusion and limit duplication. The web portal should not be a mandatory, comprehensive and continuous reporting obligation for insurers on all open and closed insurance products. Rationale: Aetna believes that a federal web portal can be created that empowers consumers through education and enhanced market competition. This portal can provide clear and salient information in a simple and appealing manner that furnishes consumers with the information they need to select appropriate and affordable coverage that meets their needs. The federal web portal serves an important transitional purpose during the initial implementation of PPACA until states develop their own web portals and establish Exchanges by The goal of the federal web portal should be to allow individual consumers, with one click, to choose the state within which they wish to investigate and obtain insurance coverage. When they reach their state page, they should receive information on Medicaid eligibility, coverage, and a link to a website through which they can enroll, if eligible, in their state's Medicaid program. On the same page, they should also receive information on state high risk pool eligibility, coverage, and a link to a website through which they 2

3 can enroll, if eligible, in the high risk pool. In addition, they should receive information on private health insurers, including a list of insurers that provide coverage within their state and the general types of coverage available from those carriers (e.g., HMO or PPO coverage). The web portal should not include detailed benefits coverage information for each insurance product, nor should it include a pricing engine that attempts to replicate the insurance company's proprietary pricing methods. Instead, the web portal should link to the insurance company's website where the consumer will obtain detailed coverage information and an estimated rate quote for their particular circumstances. The small business web portal would be much the same, but would also include information on the early retiree reinsurance program and the small business tax credit program. In 2014, when states have established their Exchanges, individuals are required to obtain health insurance, insurers are required to guarantee issue and renewal, and medical underwriting will have been eliminated, we believe the federal web portal should serve a secondary role to state web portals. At that time, because medical underwriting would be eliminated, state web portals could interface electronically with the health insurer so that consumers could obtain real-time pricing but the data would remain under insurer control and pricing methods would remain proprietary. This vision of the federal web portal accurately reflects the limited purpose that Congress envisioned. Contrary to the limited purpose envisioned by Congress, the Rule would create a web portal that is a massive, continuous and mandatory reporting regime imposed on all insurance business, including coverage that is not offered to consumers. Creating such a portal is not practical, is not cost-effective, and consumers will end up paying for these unnecessary costs. As such, Aetna strongly recommends scaling back the requirements in the Rule to be consistent with the legislative intent. The statute makes clear that the limited purpose of the federal web portal is to assist individuals and small businesses in "identify[ing] affordable health insurance coverage options" within a state. PPACA 1103(a)(1). The statute specifically explains that the portal is to "provide ways... to receive information [on] health insurance coverage offered by health insurance issuers...." PPACA 1103(a)(2) (emphasis added). Thus, the statute makes clear that the purpose of the portal is to make available information on coverage offered to the public. The statute does not require that the portal contain extensive information. In fact, PPACA only requires the provision of information "to the extent practicable," PPACA 1103(a)(2), and only limited information is mandated. Specifically, PPACA 1103(b) directs the Department to present coverage information to consumers, including (1) the percentage of non-claims costs, (2) eligibility, (3) availability, (4) premium rates, and (5) cost sharing with respect to such coverage. In addition, the Department's presentation of this information should be consistent with the new uniform explanation of coverage standards provided in PHSA That section directs the Department to develop a summary of benefits and coverage explanation that is short and understandable to the average plan enrollee. PPACA 1001, PHSA 2715(b)(1), (2). As relevant for these purposes, the summary should contain (1) a description of the coverage, including cost- 3

4 sharing, for each essential benefits category, and additional benefits identified by the Department; (2) the exceptions and limitations on coverage; (3) information on renewability and continuation of coverage; (4) illustrative common benefit scenarios; and (5) a customer service phone number. PHSA 2715(b)(3). In contrast to the limited purpose and information required by PPACA, the Rule requires health insurers in the individual and small group market to collect and produce a massive amount of information, much of which has little, if any, value to consumers. By September 3 and annually thereafter, insurers must also provide "pricing and benefit information," 45 C.F.R (b), to support the web portal's "pricing engines." 75 Fed. Reg , The preamble to the Rule indicates that this information will be "comprehensive," id. at 24473, and includes (1) premiums; (2) cost-sharing options; (3) types of services covered; (4) coverage limitations; and (5) exclusions, id. at Because the Department "believe[s] that it is inappropriate to impose a pricing and benefits information reporting burden on issuers for products and portal plans that are not open for enrollment," the Department will exempt such insurers from the additional reporting obligations for products that are not open to new enrollments. Id. The reporting obligation introduced in the second phase is continuous. Insurers must submit updated information whenever the insurer changes premiums, cost-sharing, types of services covered, coverage limitations, or exclusions for any of their products in the individual or small group market. 45 C.F.R (c). In addition, if an insurer creates a new product, or opens an existing product for new enrollment, the insurer must report the comprehensive pricing and benefits information to the Department within 30 days of offering the new or re-opened product. 45 C.F.R (d). In addition to this already voluminous amount of information, the Department has also announced its intention to gather data that even it recognizes is beyond the statutory mandate, including (1) the percent of individual market and small group market policies that are rescinded; (2) the percent of individual market policies sold at the manual rate; (3) the percent of claims that are denied under individual market and small group market policies; and (4) the number and disposition of appeals on denials to insure, pay claims and provide required preauthorizations. 75 Fed. Reg. at (discussing "Future Updates"). All of the data reported must be updated and verified annually. Id. Nothing in PPACA suggests that the Department has the authority or the need to collect such a vast amount of information from insurers. In fact, the limited purpose of the web portal is to provide an informational platform so that individuals and small businesses may make informed decisions about their health insurance coverage purchases up until the time that state portals and Exchanges are established. By 2014, the federal web portal's primary purpose should be to direct individuals to state web portals, through which individuals and small businesses may purchase Exchange coverage. See, e.g., PPACA 1311(c)(1)(5). 4

5 Despite the limited and transitional role for the federal web portal, the Rule requires that all insurers participate, that they immediately provide information on all health insurance products, including those that are not open for enrollment, and that information be updated continuously. In order to better reflect the limited and appropriate role for the web portal, the Department should revise the Rule significantly. Aetna's specific comments on revisions to the Rule are set out below. II. Specific Comments on the Rule A. Web portal should display limited pricing information and should not have a pricing engine Recommendation: We recommend that the web portal not include a pricing engine. Instead, the portal should link to each insurer's website for updated pricing information. Rationale: Pricing information for health insurance products is constantly updated by insurers. The administrative burden of tracking and updating price information by the Department and insurers would be significantly lessened if consumers were directed to a single source of information on pricing the insurer's website. It is simply more efficient to monitor and update one source of information than multiple sources of information. Plus, a single point of information will also lessen possible confusion if an insurer's website is updated with current information before the web portal is updated. Finally, we believe that pricing information is proprietary. Collecting this type of information will require additional layers of confidentiality and thereby increase the resources required by the Department in creating and maintaining the web portal. To the extent that the web portal itself may include some pricing information, we believe the best way to communicate pricing information would be to use an index rate for the policy that most closely reflects a sample policy design (e.g., PPO with $2,500 deductible). For example, an insurer could report a rate for two 30-year-old parents, one male and one female, and one 10-year-old and one 5-year-old rate for the insurer s policy closest to a sample policy specification (e.g., PPO with $2,500 deductible). Aetna also recommends that the index rates be provided by county, rather than zip code, for ease of administration. Rating is generally performed at a county level. In the event that the federal portal includes any pricing information, Aetna recommends utilizing the following census for Small Group and the following Individual age/gender/tier (family composition) combinations as a universal measure that will provide a common point of comparison for all insurers, while not overburdening all parties in satisfying the intent of the statute. 5

6 Small Group Census Employee Age Gender Tier Sample Employee 1 35 M Single Sample Employee 2 37 F Family Sample Employee 3 28 F Employee + Child(ren) Sample Employee 4 42 M Employee + Spouse Sample Employee 5 32 M Single Individual Census 1 Individual Age Gender Sample Individual 1 35 M Individual Census 2 Individual Age Gender Sample Individual 1 37 F Sample Individual 2 38 M Sample Individual 3 10 M Sample Individual 4 8 F The premiums prepared for the foregoing census will be such that only the rating factors above (age, gender, tier), where allowed by law, are included in the rates. Rating factors in the small group market that will not be considered include group size, industry, class of business, duration of coverage, participation rate, claims experience, smoking and wellness programs. For the individual market, individualized underwriting is also not included in the rates to be provided. Of course, underwriting can modify rates from those that would be provided based upon the sample census. To the extent that the Department ultimately elects to include a pricing engine, it should be done in a manner consistent with private sector online marketplaces. In these marketplaces, the exchange's role is to provide the environment and framework in which sellers can responsibly represent their products and services to buyers through a full range of transactional services that permits buyers to research, assess, compare, filter, acquire or transact, and optionally review the seller's products and services. The role of a seller in an exchange commonly centers on providing product catalogue, pricing, inventory, fulfillment and customer support services to the exchange. An exchange typically provides the interface for such seller services or alternatively provides an open framework of such services within which a seller can integrate. That is, exchanges do not recreate the core business processes or methods of sellers (e.g., pricing, customer service) but rather determine what products or services may be made available in the exchange and how those products are represented in the experience. The following successful examples from other industries in the market today are worth examining for best practices for allowing consumers to interface with sellers on an exchange: Amazon (e-tailer, marketplace) allows sellers (retailers, individuals, etc.) to integrate their data and engines e.g., inventory and pricing through Amazon Merchant Web Services, 6

7 Travelocity (online travel agent) allows sellers (airlines, hotels, etc.) to integrate their data and engines e.g., inventory and pricing through Sabre Universal Services Gateway into the portal, LendingTree (online mortgage broker) allows sellers (banks, lending institutions, etc.) to integrate their data and engines e.g., quoting and contracting through Lend-X Application Services into the portal. Each of the above examples present a very different exchange and buying experience, but each consistently acts as a facilitator that appropriately relies on the sellers for key services such as pricing. These examples suggest that it is unnecessary and overly complex to represent multiple, proprietary business operating and workflow methods for providing information on a similar product or service. Rather than requiring sellers to "hand over the data," they instead employ a method for sellers to "integrate their services" to clearly optimize roles and responsibilities and the integrity of the exchange. In the event the Department ultimately establishes a pricing engine, this is the model the Department should follow. B. The information required should be limited so that consumers can make meaningful decisions and are not overwhelmed Recommendation: We recommend that the web portal present the following limited sets of information regarding private insurance: state, types of products (e.g., HMO, PPO), and links to insurers' websites for more detailed coverage and pricing information. The Rule should not require information on plans not available to the public, information provided should not have to be updated continuously, and the information contemplated in the "Future Update" section of the Rule's preamble should be eliminated. Rationale: Consumers and small employers are most likely to base their buying decisions on a comparison of a limited set of information premiums, benefits, and other plan features (e.g., provider network participation) available to them. The ability to see and compare these factors, as contemplated through federal and state web portals and eventually through Exchanges, should be valuable to consumer purchasing decisions. Under the Rule, the consumer's ultimate purchasing decision will at best be confusing because the sheer volume of information will not educate, but will overwhelm and frustrate consumers. Indeed, it is well-established that information overload is actually detrimental to an optimal purchasing process. The Department itself notes that information on health insurance products that are not available to consumers does not assist consumers in selecting health insurance coverage. Collecting and presenting information on insurance products that are not open for enrollment is exceedingly likely to confuse and frustrate consumers, because those consumers cannot select that product for purchase. Eliminating the requirement to provide information on closed products would eliminate reporting on many plans and dramatically reduce the reporting burden. Omitting this information from the required 7

8 disclosures would be advantageous to consumers by avoiding confusion, and it would conserve the scarce resources of both the Department and insurers. The Rule requires that insurers provide updated information whenever they change "types of services covered, coverage limitations or exclusions." 45 C.F.R (c). Aetna also believes that this requirement should be eliminated. With the level of data required, there are literally tens of thousands of variations of coverage and rates by rating area for any single insurer. The terms of such coverage are regularly updated for routine benefit changes. Providing this information within 30 days of a change and updating this information within the portal will be terribly burdensome on insurers and the Department. Updated information can be provided on each insurer's website, which should be linked to the federal web portal. It is also unclear when this obligation to update information would be triggered. Many changes made to a policy or plan are not material and are not relevant to a consumer's purchasing decision because a consumer chooses a health plan based on a limited set of salient factors. At a minimum, the Rule should adopt a materiality standard to determine what information must be updated. Under such a standard, material changes that may influence a consumer's purchase will be made available to a consumer, while both the Department and insurers will be spared the burden of collecting, sorting, analyzing and presenting immaterial information. Finally, the Department should not request any information that is not specifically listed in the statute. In particular, the information set out in the "Future Update" section of the Rule's preamble should be eliminated, which relates to (1) the percentage of individual market and small group market policies that are rescinded; (2) the percentage of individual market policies sold at the manual rate; (3) the percent of claims that are denied under individual market and small group market policies; and (4) the number and disposition of appeals on denials to insure, pay claims and provide required preauthorizations. The collection of this data would not empower consumers because there is no consistency between insurers with respect to these terms and the collection of this data. This means that the information cannot be meaningfully compared across insurers. Moreover, we note that this information is entirely negative and provides insurers no opportunity to present other salient, valuable, positive information about policies and benefits and thus give consumers the opportunity to compare the strengths of various plan options and insurers. C. The Rule's aggressive deadlines should be delayed Recommendation: We recommend that the Department establish the web portal by July 1, but that it should reflect only information about PPACA, links to state web portals, where available, and links to insurers websites. Introducing additional information about insurance policies to the web portal should then be staggered, with reasonable leadtimes for insurers to gather, populate, verify and quality check the information before the information is presented on the site. 8

9 Rationale: The Rule sets forth a very aggressive set of deadlines by which all of this data which may consist of tens of thousands of variations of coverage and rates for the October 1 submission must be collected, formatted and produced. It appears that the Department has established these deadlines because the statute requires that a mechanism, including a website, be established by July 1. PPACA 1103(a)(1). However, as the Rule recognizes by launching the web portal in phases, the statute does not require that the website include insurer information or be fully functional by July 1. In fact, the web portal could not be fully functional immediately, as the standardized format that is mandated by the statute (relating to the uniform explanation of coverage under PHSA 2715) is not required to be developed until March The Department itself appears to be struggling to meet its self-imposed short term deadlines. The Rule requires that insurers submit data on the Department's template, which was released late and has included serious errors. The template was finally made available on May 14 (not May 12 as promised), so insurers were allowed to delay submissions from May 21 until May 26. There were still bugs in the template through Friday, May 21. That gave insurers at most three business days to complete the work required. In addition, the Department's staff has been so overwhelmed they cannot promptly respond to technical questions regarding the spreadsheet or substantive questions to clarify the information requested. Moreover, it appears that the Department will not have a vendor selected for future phases of the web portal until late July this will give insurers four weeks or less to gather, populate, verify and submit vast amounts of information. Given the problems that have already surfaced for this initial phase, it makes sense to reconsider the aggressive timelines imposed by the Rule. Compliance with the Rule is particularly burdensome on insurers. Aetna has already spent over 500 hours reviewing the statute and the Rule, developing processes and executing the collection, formatting, population and validation of the data to promptly and fully comply with the first phase reporting obligation. The Rule's estimate that this initial burden would be 30 hours per insurer dramatically understates the actual compliance cost in time and resources. Further, it provides very limited time for insurers to quality control the mass of information they must collect, format and produce. The Department will be faced with precisely the same problem when it receives this deluge of data from the insurers. The Department must also sort, collect and verify the data before releasing it to the public. Further, reconciling insurer data with state data will add to the burden. Consumers will be confused and mislead if faulty data is presented in the web portal and the unrealistic deadlines and estimate of burden on insurers further supports our concern that the Department is simply not aware of the massive volume of data it is requesting. As a result, we suggest that a reasonable reading of the statute is that a skeletal web portal should be established by July 1. At that point, the web portal should display introductory information about PPACA, links to state web portals, where available, and links to insurers websites. Populating the portal with information regarding actively marketed insurance policies could then be staged over time. 9

10 Launching the portal over a longer time period would give the Department additional time to consider any comments received as a result of the Rule and to further consider what information will provide consumers with the most value and the format in which it should best be presented. In addition, this additional time is likely to reduce the administrative burden on both the Department and insurers, as the Department condenses the required disclosures to only those that will assist in meaningfully educating consumers about their available health insurance coverage options. D. Participation should be voluntary Recommendation: We recommend that insurer participation in the portal be voluntary. In addition, insurers that elect to participate should have the flexibility to participate with respect to certain states and certain products. Rationale: Nothing in PPACA requires insurers to participate in the web portal. Instead, the Department is instructed to create a website to identify available health insurance coverage. As noted in the Rule, much of this information is available to consumers already, via state portals or private engines that aggregate and present insurance options to consumers for purchase. Requiring mandatory participation for insurers will provide little value, particularly if the data is unreliable because insurers were given insufficient time and guidance to properly collect and report the data. E. Web Portal should defer to existing state portals where they are established and take into account the availability of privately maintained portals Recommendation: We recommend that that Department design the web portal to link to existing state portals or state insurance department websites and not impose reporting requirements on insurers for products in those states. Direct reporting to the Department by an insurer should only be required if there is no state website that presents insurance information to consumers. Rationale: As the Department acknowledges, much of this information is already available to consumers. "For example, the State of Massachusetts already presents essentially the entire set of information we will obtain, and more, on its Connector Web site." 75 Fed. Reg. at Such a design is consistent with the statutory framework of PPACA, which clearly envisions states acting as the primary intermediary between insurers and individuals through the state-based portals and Exchanges in Reliance on state portals is also consistent with structure of much of PPACA, which amends the PHSA and therefore carefully preserves the primacy of state insurance regulation and preserves state opportunities to experiment and innovate. There are other compelling reasons to defer to state web portals. Importantly, having a single governmental source of health insurance information in a state will prevent confusion among consumers. For example, currently health insurance consumers in Massachusetts may access all the necessary information on health insurance options through the Massachusetts Connector website. A federal web portal that tries to duplicate 10

11 this information will create needless confusion and complexity, as the information required by the Department is unlikely to be identical to the information required by Massachusetts and the Department simply does not have the resources to harmonize state and federal requirements. Any variation that results between the two websites will only serve to confuse Massachusetts's consumers. This concern is not only limited to Massachusetts, however. The Rule recognizes that other parties may present and aggregate similar data. 75 Fed. Reg. at Currently, several organizations are actively filling such roles. There is a risk that without thoughtful design and implementation, the federal web portal will be an inferior alternative to these private websites. This result would deprive consumers of the additional information that the web portal will provide about government programs and other benefits available under PPACA, it will waste the Department's limited resources and time, and it has the potential to harm insurers' business. As a result, we urge the Department to take the time necessary to carefully design and implement the web portal. The presentation of this information is critical to improve consumer access to health insurance coverage and avoid consumer confusion and frustration. In addition, a separate federal reporting process with different standards, definitions and requirements than that which is already required by the states would add unnecessary administrative costs and overall burden to the system. Such additional costs and burdens would not produce added consumer value but would deluge the Department with unnecessary and potentially conflicting information. We note that states are being asked to provide some of the same information as insurers and the Department lacks the resources and ability to reconcile this information. At a minimum, deferring to state portals would allow the Department more flexibility in the allocation of its resources, by avoiding the annual update and verification of the myriad products that are already extensively explained and disclosed by states. F. The Rule includes vague and undefined terms that require clarity Recommendation: We recommend that the Department define the terms it uses to describe the information it requires insurers to disclose and to require the disclosure of this information on a prospective basis only, so that insurers may adjust their systems and procedures to accurately capture the required information. Rationale: The Rule directs insurers to produce a great deal of specific information, but without any guidance as to what precise information the Department intends to capture or how it will be used. For example, in the initial set of required information, the Rule asked for the submission of "enrollment codes." This term is undefined. We recommend that the Department define "enrollment codes" to mean the administrative code assigned by an insurer and used internally to distinguish between specific benefit options. The Department also intends to eventually collect information on "rescinded" policies and "denials to insure, pay claims and provide required preauthorizations." Although we oppose the collection of this information as outside the scope of the statute, if HHS 11

12 nonetheless pursues this collection, we recommend that these critical terms be defined. Each of these terms or phrases may have internal meaning to individual insurers, but there is no consensus meaning. In the unlikely event that consumers found this information useful, if there is no defined meaning for these terms and phrases, consumers will be unable to meaningfully compare policies based on these metrics. As such, these terms must be prospectively defined so insurers can capture and submit information that would permit "apples to apples" comparisons. G. Penalties Recommendation: We recommend that the Department state explicitly that there is no penalty for failure to comply with the web portal data reporting obligations. In the alternative, we recommend that the Department require only good faith compliance with web portal data reporting obligations and that the penalty for failure to make a good faith compliance effort is for the insurer to be excluded from participation in the web portal for a period not to exceed one year. Rationale: Although the preamble suggests that the Department intends to "communicate through the Web portal and other public communication processes, such as presentations and reports to stakeholders, the names of those issuers who fail to timely meet the reporting requirements or who provide incomplete or inaccurate information," see 75 Fed. Reg. at 24473, neither PPACA nor the Rule includes a specific penalty. Insurers need certainty regarding the potential risk and liability associated with noncompliance since the reporting obligations are so substantial and the timeframes are so unrealistic. H. Verification and certification Recommendation: We recommend that the Department state explicitly that "verification" required under the Rule is complete when the data is submitted to the Department without error. We further recommend that the Department abandon the requirement that data submissions be "certified" by the CEO or CFO of the insurer. Rationale: The Rule requires insurers to annually "verify" all of the data submitted to the Department, but fails to explain the purpose of the verification and the steps an insurer must take to verify the data. We understand from the data template instructions that the data in the spreadsheet is verified by the macros embedded in the spreadsheet. It would be helpful to insurers if the Department would make clear that this internal spreadsheet verification is all that is required by the Rule's verification requirement. Similarly, beginning with the data that must be submitted by September 3, 2010, the Rule requires that an insurer's CEO or CFO "certify" the accuracy and completeness of the data. The Rule contains no explanation or justification for this certification. Nor does the Rule explain what penalty, if any, attaches for failing to certify the data submitted. Because there is no statutory authority in PPACA for imposing this certification obligation on insurers, and because CEOs and CFOs are unlikely to have actual knowledge of the completeness and accuracy of the data submission, and because the 12

13 Rule already requires that the data be verified for each submission, the Department should abandon this requirement. * * * Aetna is pleased to have the opportunity to provide comments regarding the Health Care Reform Insurance Web Portal Requirements. Thank you for considering our comments. Should you have any questions, please feel free to contact me at kelmars@aetna.com. Sincerely, Steven B. Kelmar Senior Vice President Government Affairs and Public Policy kelmars@aetna.com