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Monday, 14 May 2018 09:48

The Latest ACA Regulatory Changes

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The final Affordable Care Act provisions for 2019 have been released and they are in line with the regulations proposed on October 27, 2017. The provisions primarily concern the out-of-pocket maximums, Essential Health Benefits (EHBs), and the Marketplace.

Out-Of-Pocket Maximums

The new regulations have increased the limit on out-of-pocket maximums for all non-grandfathered plans moving into the 2019 year. The individual limit has risen to $7,900 dollars and the family limit has been increased to $15,800. It is important to note that these limits apply regardless of group size or funding type (such as fully insured, self-funded or partially self-funded).

Essential Health Benefits (EHBs)

Regulations for plans starting January 1st, 2020 are designed to grant states more freedom and flexibility when deciding on EHB benchmark plans. The regulation is designed to allow states to follow current rules while maintaining 2017 benchmark plans or to select new benchmark plans annually.

To select a new EHB benchmark plan, states can use one of the following options:

  1. Adopt another state’s 2017 EHB benchmark plan

  2. Replace any number of the 10 required categories

  3. Use a new set of benefits to use as the benchmark plan

To select a new benchmark plan, in part or in whole, the new plan must meet 2 requirements:

  1. The new or modified benchmark plan must have the same or greater scope of benefits to a “typical employer plan”

  2. The plan cannot be more generous than the most generous comparison plan 

Marketplace changes

  • There have been several updates and changes to the marketplace plans. The most important are highlighted below

  • Updated risk adjustment model for insurers with high-cost enrollees

  • Updated special enrollment period rules for coverage effective dates specific to adding or changing dependents

  • Changed network adequacy reviews for qualified health plan certifications, now deferred to the states

  • Changed requirements for marketplaces to check eligibility and enrollment in the qualifying employer-sponsored coverage

  • Change granting marketplaces to determine exemptions based on affordability of the lowest-cost metal level plan available

  • Change granting enrollees to request same-day termination of coverage

  • Removal of several Small Business Health Options Program (SHOP) requirements for online enrollments

  • Added a new special enrollment period for women who were receiving coverage through the children’s health insurance program (CHIP) but lose that access

A lot has changed, which is the nature of the healthcare insurance market. For the entire release, click here.

If you do have any questions about if or how any of these regulations affect your plans, give us a call.


Read 641 times Last modified on Thursday, 31 May 2018 15:35