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PAHUs Letter to Congress on Health Reform
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** NAHU's Magazine **
The Health Insurance Underwriter!


PPACA Information

This section is regularly updated

HHS Issues EBH, Wellness, Rate Band Rules
On November 26, HHS's massive new regulations dealing with parts of the Patient Protection Affordable Care Act (PPACA) appeared in the Federal Register but did not include anticipated Exchange rules. First, essential health benefits (EHBs) were addressed. Earlier, states were given options of deciding between several benefit scenarios for EHB benchmark plans and were given a deadline of October 1, 2012 to tell HHS which EHB scheme would be used. PA sent a letter seeking clarification. This proposed rule spells out what the default would be for EHBs for those states not deciding on their own. "Specifically, we propose that HHS would supplement the category of benefits in the default base-benchmark plan with the first of the following options that offer benefits in that particular EHB category: (1) The largest plan by enrollment in the second largest product in the state's small group market as defined in § 155.20; (2) the largest plan by enrollment in the third largest product in the state's small group market as defined in § 155.20; (3) the largest national FEHBP plan by enrollment across states that is described in and offered to Federal employees under 5 U.S.C. 8903". The law directs that EHB be equal to benefits covered by a typical employer plan and cover at least the following 10 general categories: Ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
The rule also addresses a provision in PPACA that says that state mandated benefits not included in the EHBs offered by the Qualifying Health Plans for Exchanges must be paid for by the state. It says that EHBs would be presumed to include any states mandates enacted before January 1, 2012. Actuarial value used for determining the coverage level (bronze, silver, gold, platinum) was also included in this rule. Wellness programs were addressed in another November 26 rule with HHS saying that smokers in a cessation class would be eligible for an up to 50% offset to their premium. Other than that, the maximum discount for others achieving wellness goals (weight, blood pressure, cholesterol) would be increased from 20 to 30%.
A third HHS rule said that the transition to a 3-1 rate band where no one’s rate could be more than three times another's would be more gradual. Critics pointed to an outcome of compressing the rate bands which would mean dramatic increases for younger, healthier individuals even as premiums for older and more claims-prone populations would decrease. The rule would phase in yearly rate increases for persons aged 21-63 on a gradual basis instead of a sudden sticker shock. A single band would be used for children up through 19 and persons 64 and older.

PAHU Provides Summary for Employers By Size <<< Click Here >>>

20 Things Employers Need to Know about PPACA <<< Click Here >>>

PPACA Benefits Summary Regulations Issued <<< Click Here >>>

IRS Posts Notice on PPACA W2 Requirement <<< Click Here >>>

HHS Releases Essential Benefits Proposal <<< Click Here >>>

PPACA Early Retiree Program Runs Out of Money <<< Click Here >>>

Pennsylvanians should keep in mind that the July 2011 Proposed Rule regarding PPACA Health Insurance Exchanges invites public comment until October. Second, Pennsylvania needs to pass legislation enacting Exchanges. The Commonwealth will decide the roles of insurance agents/brokers in marketing Exchanges as well as rules for companies. PA's General Assembly also will decide what form the PPACA Navigators will take.
HHS Issues Draft Exchange Rule <<< Click Here >>>

Kaiser Family Foundation Timeline: Includes Medicare/Medicaid <<< Click Here >>>

Code Blue: New PPACA Guidance Issued <<< Click Here >>>

IRS Releases Draft Form for Small Firms to Claim Health Care Tax Credit <<< Click Here >>>

Practical Health Care (Implementing Health Care Reform) <<< Click Here >>>

Nursing Rules at Work per PPACA <<< Click Here >>>

Explanation of D26 <<< Click Here >>>
and <<< Here >>>

Business Compliance Outline <<< Click Here >>>

Health Reform Grandfather Rules <<< Click Here >>>

NAIC Issues Grandfather guidance <<< Click Here >>>

Implementation Timeline <<< Click Here >>>