CMS recently released the Proposed Rule for Benefit and Payment Parameters for 2016, which is now open to comments.
NAHU is hard at work putting together our suggestions, but we thought you might like to see what’s included in the proposed rule. Some of these are ideas the association has been working on for quite some time.
- Reinsurance Contribution in 2016- $27 (previously $44).
- Marketplace open enrollment for 2016 coverage will be Oct. 1, 2015- Dec. 15, 2015- coverage effective date of Jan. 1, 2016.
- New Special Enrollment Period for individual in a non-calendar year employer plan to come off the employer plan and enroll in the exchange mid-year. This was not previously allowed.
- Individual mandate exemption increased from 8% of household income to 8.1%.
- SHOPs- in 2016, SHOPS will be permitted to assist employers with COBRA premium processing (collect directly from participants and forward to insurer). Employer is still responsible for notice requirements and other administrative functions.
- OOP max- increases to $6,850 for self-only and $13,700 for family. (currently $6,600 and $13,200). Note that these are different from the HDHP MOOPs.
- Pediatric dental and vision, offered to children through the end of the calendar year in which they turn 19 years of age. Currently only required until age 19.
- Cannot limit prescription drug coverage to mail-order only.
- Guaranteed Renewability- still includes testing for participation outside the FFM- but coverage in the individual market will count towards participation.
- Minimum Value- incorporated the new requirements that a group health plan must include hospitalization and substantial inpatient/ physician services in order to be considered to provide minimum value. However, the term “substantial” was left undefined.
- MLR- Currently, a group health plan that is subject to ERISA and receives a MLR rebate (which represents plan assets) must use the rebate within three months or place the rebate amount in trust. Non-federal government plans and church plans are not subject to ERISA and do not have a similar timeframe imposed to use the rebate. The regulations propose that employer plan sponsors not subject to ERISA must use the rebate within three months. They could use the rebate to reduce the employees’ portion of premium for the subsequent policy year (including spreading the reduction over all 12 months of the policy year), but the policy year must begin within three months of receiving the rebate. Otherwise the employer must distribute the rebate in the form of a cash refund or apply a mid-year premium credit to the employees.
- CMS is accepting comments on the proposed regulations through Dec. 26, 2014.