HHS ISSUES FINAL RULE AFFECTING ACA FOR 2016

February 27, 2015

On Feb. 27, 2015, the Department of Health and Human Services (HHS) published its final Notice of Benefit and Payment Parameters for 2016. This final rule describes benefit and payment parameters applicable to the 2016 benefit year, including standards relating to:

 

·   The reinsurance program’s annual contribution rate for 2016;

·   The 2016 open enrollment period for individual policies; and

·   The 2016 annual limitations on cost-sharing.

 

The reinsurance program is a transitional program to help stabilize premiums for individual market coverage during the first three years of Exchange operation, from 2014 to 2016. The program collects a fee from health insurance issuers and some self- insured group health plans. The 2015 rate is $44 per enrollee, and the 2016 rate is $27 per enrollee.

 

The final rule also sets the annual open enrollment period for non-grandfathered policies in the individual market for the 2016 benefit year and beyond. The final rule changes the open enrollment period from the proposed notice. The annual open enrollment period for 2016 will be Nov. 1, 2015, through Jan. 31, 2016.

 

Additionally, the rule set the annual limitation on cost-sharing. The Affordable Care Act (ACA) requires non-grandfathered health plans to have an out-of-pocket maximum on essential health benefits. This overall annual limit must be updated annually. For 2015, the out-of-pocket maximum is $6,600 for self-only coverage and $13,200 for family coverage. Under the final rule, for 2016 the out-of-pocket maximum increases to $6,850 for self-only coverage and $13,700 for family coverage.

 

The final rule also clarifies that the annual limit on cost-sharing applies to the plan year, not the calendar year, for non-calendar year plans. In addition, the self-only coverage maximum applies for any individual, whether that individual is covered under either a self-only or a family health plan. 

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