PPACA Updates and rule clarifications

[MichaelB]

HHS today published new details on PPACA implementation and also proposed new rules

From the Kaiser Family Foundation Administration Releases New Health Law Rules For Insurers, Employers - Kaiser Health News
From HHS Obama administration moves forward to implement health care law, ban discrimination against people with pre-existing conditions

Quote:

Long-awaited details on how insurers can structure health benefits and premiums for policies that will cover tens of millions of Americans starting in 2014 were released by the Obama administration Tuesday.

Essential health benefits that policies must carry was clarified. These are a “core package” of benefits all policies must cover, but coverage details had not yet been defined.

Quote:

The long-awaited guidance gives states four choices for designing a benchmark insurance package. Regulators can base their package on the benefits offered by: one of the three largest state employee health plans (by enrollment); one of the three largest federal employee health plan options; the largest HMO plan offered in the state or one of the three largest small-group plans in the state. HHS Gives States Flexibility On Health Law's 'Essential Benefits' - Kaiser Health News

How premiums can vary with age, family size, geography and tobacco use was defined. Here is a nice table from the Washington Post for age.


There is also a report that some policies may be allowed to offer deductible amounts greater than $2k. This is reported here but I don’t see anything at HSS or KFF. Still, it is of interest here at the forum.

Rules and details for wellness programs were also proposed.

[Midpack]

Thanks for all the very helpful guidance you provide on PPACA, it's much appreciated by many I am sure. I took a look at the two links, but I'll want to reread and study it all more closely tomorrow, when I haven't just finished a Mexican dinner with a margarita...

[rbmrtn]

Quote:

Originally Posted by MichaelB There is also a report that some policies may be allowed to offer deductible amounts greater than $2k. This is reported here but I don’t see anything at HSS or KFF. Still, it is of interest here at the forum.

I had started to read through some of this before you posted. It looks like this is in the proposed changes for 45CFR156 and allows it if a plan can not obtain the coverage level.

http://www.ofr.gov/OFRUpload/OFRData/2012-28362_PI.pdf


In §156.130(b)(3), we propose that a plan may exceed the annual deductible limit if it cannot reasonably reach a given level of coverage (metal tier) without doing so.

[Animorph]

That age table makes it clear that we can't complain too much about above-inflation rate increases in individual insurance rates. Quite a bit of cost just for getting a year older. I would think larger groups that have a stable average age would seem to hold their costs down a little better. Thanks.

[MichaelB]

Quote:

Originally Posted by Midpack Thanks for all the very helpful guidance you provide on PPACA, it's much appreciated by many I am sure. I took a look at the two links, but I'll want to reread and study it all more closely tomorrow, when I haven't just finished a Mexican dinner with a margarita...

Thanks. In retrospect I could have summed things up better. Perhaps the margarita would have helped.

[MichaelB]

Quote:

Originally Posted by rbmrtn I had started to read through some of this before you posted. It looks like this is in the proposed changes for 45CFR156 and allows it if a plan can not obtain the coverage level. http://www.ofr.gov/OFRUpload/OFRData/2012-28362_PI.pdf In §156.130(b)(3), we propose that a plan may exceed the annual deductible limit if it cannot reasonably reach a given level of coverage (metal tier) without doing so.

That's it. Thanks for reading through all that - it was too much for me.

Quote:

Originally Posted by Animorph That age table makes it clear that we can't complain too much about above-inflation rate increases in individual insurance rates. Quite a bit of cost just for getting a year older. I would think larger groups that have a stable average age would seem to hold their costs down a little better. Thanks.

My take on the table is favorable, but probably because I am more familiar with the current one used. The difference between the lowest and highest rate based on age is 10x, and that is falling to 3x. The table shows it will not be a big jump but stepped up.

My take is these rules and clarifications were meant to gain support, especially of the states. Insurance companies already support and now will be in implementation mode.

[donheff]

I wonder if HHS will just be able to team up with OPM and piggyback the Federal health insurance program to offer state exchanges to those who don't join in -- i.e. offer the national fee for service plans and any local FFSs and HMOs for the given state. They could probably add an option for companies to apply to participate at the state level only in the annual providers open season. Seems like a simple approach to solving the problem.

[Live And Learn]

Quote:

Originally Posted by Midpack Thanks for all the very helpful guidance you provide on PPACA, it's much appreciated by many I am sure.

+1. Very much appreciated indeed.

I will be digging into the information in the links you have provided right now.