The Department of Health and Human Services (HHS) has released key standards for health insurers and the federal Marketplace. These extend many policies into the next year and allow for smooth transitions, so that consumers, employers, carriers—and you, the broker—can plan for the future.
Here are some key ACA requirements you should know:
- Small Business Health Options Program (SHOP)
HHS has finalized several standards for the employee choice and premium aggregation provisions in federally funded Small Business Health Options Programs (FF-SHOPs):
--Through the FF-SHOPs, employers can offer employees either a single stand-alone dental plan or a choice of all stand-alone dental plans available at a stand-alone dental AV level.
--The FF-SHOP will send each participating employer a single monthly bill covering all employees covered through the FF-SHOP and the employer will remit a single monthly payment to the FF-SHOP. CMS will provide these “premium aggregation” services for all issuers participating in the FF-SHOP, regardless of whether an employer chooses to offer a single plan or all plans at a single actuarial value level of coverage through employee choice.
--Sometime after January 2015, the FF-SHOP will allow employers to contribute differently to the premiums of full-time and part-time employees. When employers offer a choice of plans to employees, they can set premiums using a per-member rating.
--HHS has also confirmed that a company that enters the SHOP as a small employer—and then down the road becomes a large employer—would continue to be rated as a small employer.
- Annual Limitations on Cost Sharing
The ACA sets limits on cost sharing to protect people from excessive out-of-pocket expenses. Per the statute, these limits must be updated annually based on the percent increase in average premiums per enrollee for health insurance coverage. HHS updated these limits based on projections of average per enrollee premiums. The premium adjustment percentage for 2015 is 4.21 percent, which works out to:
--Maximum annual limitation on cost sharing for self-only coverage of $6,600 ($13,200 for families).
--Maximum annual limitation on deductibles for plans in the small group market for self-only coverage of $2,050 ($4,100 for families).
- Open Enrollment Period
The open enrollment period benefit year is November 15, through February 15. This gives:
--Carriers time to set their yearly rates and submit their Qualified Health Plan (QHP) applications
--States and HHS more time to prepare for open enrollment
--Consumers three months to shop for coverage
- Consumer Protections
Also new on the medical side is the implementation of patient safety standards so consumers have access to health care that meets sufficient safety and quality standards. Brokers should make note of the following, which is good info to be aware of:
--For the initial two years, HHS is aligning QHP carrier standards with Medicare Hospital Condition of Participation requirements for a quality assessment and performance improvement program and discharge planning.
--Additionally, to make sure all QHPs offered through the federal Marketplace are in the interests of qualified individuals and qualified employers, plans must be considered “meaningfully different” from all other plans offered by the same carrier in order to be certified as a QHP in the FFM.
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