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US health news

ACA Cost Sharing Limits Benefit AV Standards Proposed  

Dec 09 2015

Annual cost-sharing limits for non-grandfathered group health plans would increase to $7,150 for individuals and $14,300 for families in 2017, under a CMS proposal issued Nov. 20. Other changes in the proposed Notice of Benefit and Payment Parameters for 2017 would amend the guaranteed-availability and renewability rules for large- and small-group insurance; expand employees' choices for SHOP exchange plans; offer more flexibility for student health plans; revise risk-adjustment calculations and charges; and clarify what is not an essential health benefit.

Other parts of the proposal address benefit and operational matters for ACA exchanges, including specific network-adequacy criteria for qualified health plans and optional standardized cost sharing for plans at each actuarial "metal" level. It also would modify the exchange processes for notifying employers when an employee is determined eligible for exchange subsidies and for handling employer appeals.

Also on Nov. 20, but in a separate notice, CMS released a draft updated actuarial value calculator and methodology. The draft calculator does not affect any 2016 plans and will only be applicable for 2017 plans.

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Geoff Manville
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