Proposed 2016 Benefit and Payment Parameters
Posted by Linda Rowings
UBA Chief Compliance Officer
The Department of Health and Human Services (HHS) has issued its proposed Benefit and Payment Parameters for 2016. While these amounts and dates are not yet final, they may be of help for planning purposes. At this time, HHS expects:
- Open enrollment for coverage through the Marketplace in 2016 will be from October 1 through December 15, 2015 (with coverage effective as of January 1, 2016).
- The transitional reinsurance fee for 2016 is likely to be $27 per covered life. Filing for 2016 would be due November 15, 2016, with $21.60 per covered life due January 15, 2017, and $5.40 per covered life due November 15, 2017.
- The out-of-pocket limits for health plans that are not high deductible plans related to HSAs would be $6,850 for single coverage and $13,700 for family coverage (with a maximum out-of-pocket for any family member of $6,850).
- The federally facilitated exchange fee would remain at 3.5% of premium.
- A special enrollment period would be available at renewal for individuals enrolled in non-calendar year plans.
- Retirees and COBRA participants could be covered through a Small Business Health Options Program (SHOP) plan.
- The current benchmark plans for essential health benefits would remain in effect for 2016, with new benchmark plans based on 2014 benefits and enrollment in effect for 2017.
A draft of an updated AV calculator and methodology for 2016 also are available. While this will help you stay forward-thinking, don’t forget about taking steps to ensure you are prepared to meet the Patient Protection and Affordable Care Act (PPACA) requirements that begin in 2015 and those which must be completed in 2014. For a complete checklist, download UBA's PPACA Advisor, "Preparing for 2015 - Key PPACA Requirements".