Late last year, the Department of Health and Human Services (HHS) released proposed regulations that include the benefit and payment parameters for 2019. The regs also include a host of other potential rules related to the insurance market and Health Insurance Marketplaces (commonly known as "exchanges").
The agency's proposals are largely aimed at insurers and state regulators, but there are some provisions that may be of interest to employers and their advisors. Here are some highlights:
Increased annual cost-sharing limits. The HHS has proposed an increase in the maximum annual limitation on cost-sharing for 2019 to $7,900 for self-only coverage and $15,800 for other than self-only coverage (compared to $7,350 and $14,700, respectively, for 2018).
Revised essential health benefit (EHB) options. The proposals would provide states more flexibility in selecting EHB benchmark plans beginning with the 2019 benefit year. In addition to allowing states to select a new EHB benchmark plan annually, the proposed regs would provide states with flexibility to select among more options. For example, a state could construct an EHB benchmark plan that incorporates the 10 required EHB categories by replacing any EHB category with the one used in another state's benchmark plan. In other words, you can take different categories from different states, as desired.
The requirement to offer EHBs applies to insured health plans in the individual and small group markets. Although employer-sponsored self-insured health plans and insured large group health plans aren't required to offer EHBs, the proposed changes could nonetheless impact these plans because they may not impose annual or lifetime dollar limits on EHBs they do offer.
New rules for Small Business Health Options Programs (SHOPs). The proposed regulations, as well as a simultaneously released memo by the Centers for Medicare and Medicaid Services (CMS), address previously identified shortcomings in the current SHOP enrollment process. The proposals would remove a number of SHOP requirements for enrollment through an online SHOP and allow groups to enroll directly through a SHOP insurer or SHOP-registered agent or broker. The federal SHOPs would generally adopt this enrollment approach for plan years beginning on or after January 1, 2018, but state-based SHOPs would have the option to maintain current operations of their online SHOP enrollment platforms.
The small business health care tax credit would continue to be available to qualifying employers using direct enrollment through a simplified eligibility determination on HealthCare.gov. Additional changes proposed for SHOPs include revised premium rating standards and group participation rules.
The proposal to eliminate the federal SHOP enrollment process starting in 2018 comes as no surprise ― the CMS announced its intention to do so last May. It's now clear that, if these proposals are finalized, the federal SHOP services such as employee eligibility determinations and premium aggregation functions would also be eliminated.
Promotion of high-deductible health plans (HDHPs). In the final benefits and parameters for 2018, the HHS added to the federal Health Insurance Marketplace a standardized plan option at the bronze level of coverage that qualifies as an HSA-eligible HDHP. Following that addition, the 2019 proposals indicate an interest in encouraging insurers to offer these plans. The agency noted that the proportion of available HDHPs eligible to be accompanied by a Health Savings Account has been stable in the federal Health Insurance Marketplace, while the percentage of enrollees in HDHPs has decreased slightly over the last three years. The HHS also asks for comments on how to use HealthCare.gov to promote the availability of these plans to enrollees.
Also late last year, the Department of Health and Human Services (HHS) issued guidance addressing coverage requirements and administrative issues related to National Medical Support Notices (NMSNs).An NMSN is a standardized medical child support order used by state child support enforcement agencies to obtain group health coverage for children. If appropriately completed, an NMSN is deemed to be a qualified medical child support order that employers and plan administrators must process in accordance with Department of Labor and HHS regulations and the instructions in the NMSN. Here are highlights from the guidance:
COBRA clarification. The HHS clarified that an NMSN may cover a child of a terminated employee even if the employee elects self-only COBRA coverage. The guidance explains that a child covered by a group health plan is a qualified beneficiary with his or her own right to elect continuation coverage under COBRA — if the plan is subject to COBRA and the child loses coverage because of a qualifying event.
Privacy rule. The HHS confirmed that a plan administrator or employer may respond to a request for private medical information from a child support agency issuing an NMSN without violating the privacy rule of the Health Insurance Portability and Accountability Act.
Consumer protection limits. The guidance cautions that, in most states, deductions from an employee's pay for medical support are subject to limits set by the Consumer Credit Protection Act (CCPA). But some states require that medical support premiums be withheld before calculating the maximum withholding limit under the CCPA. Employers are advised to stop withholding premiums if an employee cannot make the payments within the CCPA limits and to notify the child support agency."
Reasonable cost" or "ACA affordability." Explaining that the child support agency generally determines whether the cost to cover a child is reasonable, the HHS advises that the employer isn't required to determine whether a parent meets the Affordable Care Act's affordability test before enrolling a child. If a child support agency sends an NMSN, the employer must use the child support definition of reasonable cost, not the affordability test.
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