Proposed Regulations - 2018 Notice of Benefit and Payment Parameters
September 2, 2016
On August 29, 2016, the Department of Health and Human Services (HHS) issued proposed regulations related to a wide range of Affordable Care Act (ACA) benefit provisions. HHS publishes rules addressing many of these same benefit provisions each year to take effect during the following plan year.
These proposed regulations will be effective for the 2018 plan year. The regulations had a 30-day comment period and requested input on a variety of topics.
On the same day, the Centers for Medicare & Medicaid Services (CMS) posted the draft 2018 Actuarial Value Calculator and Methodology. The calculator is used by insurers in the individual and small group market to determine their plans’ “metal” level (bronze, silver, gold or platinum).
Links to the calculator and all documents can be found below.
The proposed regulations include an increase to the consumer out-of-pocket maximum, which will directly impact large group health plans. All remaining provision updates directly impact individual and small group markets.2018 Out-of-Pocket Maximums The proposed 2018 annual out-of-pocket maximums are $7,350 for individual coverage and $14,700 for family coverage ($7,150 for individual, $14,300 for family in 2017).
Many of the provisions relate to strengthening the Health Insurance Marketplace by:
- Updating the risk adjustment program for insurers with high-cost enrollees
- Ensuring that special enrollment period rules are enforced
- Attracting additional young, healthy participants to the Marketplace
- Removing barriers to new insurers entering the Marketplace
- Ensuring that enrollees transition to Medicare when they become eligible
- Increasing the number of standardized plan options
- Allowing greater flexibility in Bronze plan designs
- Enhancing the direct enrollment process through web brokers
Review the information at these links for additional details.
View the 2018 Draft Actuarial Value Calculator (Note: If you are using Internet Explorer, you may need to right click the link and select "Save Target As...")
We encourage you to bookmark Cigna's health care reform website, www.informedonreform.com/, where we continuously update information as it becomes available.
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