December 2012 Health Care Reform

December 2012 Health Care Reform

by Posted on: December 4, 2012Categories: HR & Compliance   

At Clarke & Company Benefits we recognize the changes that are about come in 2014. We are working to keep on top of the changes and bringing you the most up-to-date topics on the Health Care Reform. Beginning in 2014, the Affordable Care Act (ACA) requires certain plans to offer a comprehensive package of items and services that meets certain actuarial value requirements, known as an essential health benefits (EHB) package. This requirement applies to non-grandfathered plans in the individual and small group markets. Additionally, ACA requires issuers offering coverage in a state insurance exchange (Exchange) to be accredited and imposes requirements for accreditation.

The proposed rule confirms prior guidance defining EHB based on a state-specific benchmark plan and requiring all plans that cover EHB to offer benefits that are substantially equal to those offered by the benchmark plan. ACA’s essential health benefits requirement applies to plans offered inside and outside of the Exchanges, which are scheduled to become effective in 2014.

“Metal Levels” are intended to allow consumers to compare plans with similar levels of coverage in order to help consumers make an informed decision about their health insurance coverage. The HHS has proposed an AV calculator to help issuers determine health plan AVs based on a national, standard population. In 2015 the HHS will accept state-specific data sets for the standard population if states choose to submit alternate data for the calculator. For more information about the AV calculator and the “metal levels” click on the link below.


Additional Resources:

Click here to view the legislative brief

Click here to view the Department of Health & Human Services Proposed Rule 




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