Alaska Health Insurance Policy Requirements

Alaska has comprehensive health insurance regulations that protect consumers. Understanding these state-specific rules is essential for the licensing exam.

Regulatory Structure

Alaska health coverage is regulated by the Alaska Division of Insurance:

Alaska's Unique Structure

Unlike states like California that have separate agencies for HMOs, Alaska regulates all health insurance through a single Division of Insurance under the Department of Commerce, Community, and Economic Development.

Free Look Period

Alaska provides a 10-day free look period for individual health insurance:

• Policyholder can return for full premium refund
• Begins when policy is delivered
• Applies to individual health policies
• Same as life insurance free look period

Exam Tip: Alaska uses a consistent 10-day free look period for both health and life insurance, making it easier to remember.

Network Adequacy Requirements

Alaska has unique network adequacy rules:

Out-of-Network Coverage Required

Under AS 21.07.030, AS 21.51.120, and AS 21.54.020:

• Insurers must give insureds a choice of provider
• Insurers are prohibited from restricting coverage to only contracted providers
• Benefits must be provided for services from non-contracted providers

Alaska Specific: This is a significant consumer protection not found in most states. Alaskans cannot be denied coverage simply for using out-of-network providers.

80th Percentile Rule (Repealed)

Note: The 80th percentile rule requiring payment at the 80th percentile for out-of-network services was repealed effective January 2024.

Required Coverage

Alaska follows federal essential health benefits requirements for ACA-compliant plans:

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Mental Health Parity

Alaska follows federal mental health parity requirements:

• Mental health benefits must be equal to medical benefits
• Same copays, deductibles, and limits
• Covers mental illness and substance use disorders
• Applies to group and individual plans

Pre-Existing Condition Protections

For ACA-compliant plans, Alaska prohibits pre-existing condition exclusions:

Healthcare.gov Marketplace

Alaska uses the federal Healthcare.gov marketplace:

• Only place to get premium subsidies
• Offers qualified health plans (QHPs)
• Open enrollment: November 1 - January 15
• Administers Medicaid eligibility screening
• Two carriers for 2026: Moda Health Plan and Premera Blue Cross Blue Shield of Alaska

Key Features

• Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)
• Premium tax credits based on income
• Cost-sharing reductions for Silver plans
• Special enrollment for qualifying life events

Short-Term Health Insurance

Alaska allows short-term health insurance with specific rules:

Alaska Short-Term Plan Requirements

• Rates and forms must be filed with and approved by the Division
• Subject to prompt payment of claims rules
• No state-specific duration limits (follows federal rules)
• No state benefit mandates for short-term plans

Important Distinctions

Guaranteed Issue and Renewal

Alaska requires for ACA-compliant plans:

Guaranteed Issue

• Insurers must accept all applicants
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Insurers cannot cancel coverage except for:
  • Non-payment of premium
  • Fraud or misrepresentation
  • Plan discontinuation (with notice)

Grace Period Requirements

Pharmacy Benefits Manager (PBM) Regulations

As of 2025, Alaska has enhanced PBM oversight:

• PBMs must register with the Division of Insurance
• Required disclosures of ownership and financials
• Reimbursement records must be maintained for regulatory access