New HHS Guidelines Released - EHB / Premiums / Wellness

[Yagents]

Here you go, it's only 130 pages and 81 pages long:

[FONT=Arial, Helvetica, sans-serif]One proposed rule looks at how insurers can vary premiums based on age, tobacco use, family size and geography. A second outlines proposed rules for essential health benefits. A third proposed rule would govern employer-based wellness programs.

HHS Releases Proposed Rules On Essential Health Benefits, Other Key Parts Of Health Law - Kaiser Health News

http://www.ofr.gov/OFRUpload/OFRData/2012-28428_PI.pdf

http://www.dol.gov/ebsa/pdf/wellnessproposedregulation.pdf
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[somarco]

Sure looks like fun. I notice there are several agencies at work here. HHS, CMS, EBSA, IRS, DOL and probably a few I missed.

 

[Yagents]

Another 119 pages on actuarial value:
http://www.ofr.gov/OFRUpload/OFRData/2012-28362_PI.pdf

 

[somarco]

Health insurance is now a federally regulated commodity similar to utilities.

 

[Yagents]

You are so right, they even have authority over approval of qualified plans on the exchange:

This one is only 2 pages long:
http://www.ofr.gov/OFRUpload/OFRData/2012-28440_PI.pdf

 

[somarco]

This is going to be so much fun for the agents that want to play along.

I am not one of them.

I now believe there will be a market for those who want to purchase outside the exchange, but if I have to put up with this kind of BS I won't even take part in that either.

 

[AllenChicago]

Another 119 pages on actuarial value:
http://www.ofr.gov/OFRUpload/OFRData/2012-28362_PI.pdf

This wording from the Executive Summary of the document answers a big question I had...

"Executive Summary: Beginning in 2014, all non-grandfathered health insurance coverage in the individual and small group markets, Medicaid benchmark and benchmark-equivalent plans, and Basic Health Programs (if applicable) will be required to cover essential health benefits (EHB), which include items and services in 10 statutory benefit categories, such as hospitalization, prescription drugs, and maternity and newborn care, and are equal in scope to a typical employer health plan."

I Believe this is saying that ALL policies effective after March 23, 2010 must have these 10 benefit categories added. Maternity and Prescription coverage alone will make every existing non-grandfathered policy premium increase by at least a couple hundred dollars a month.

Even if the sole owner of a policy is male, must maternity coverage still be added? Or, would it be discriminatory to not require that males have maternity coverage?
-ac

 

[Yagents]

This wording from the Executive Summary of the document answers a big question I had...

"Executive Summary: Beginning in 2014, all non-grandfathered health insurance coverage in the individual and small group markets, Medicaid benchmark and benchmark-equivalent plans, and Basic Health Programs (if applicable) will be required to cover essential health benefits (EHB), which include items and services in 10 statutory benefit categories, such as hospitalization, prescription drugs, and maternity and newborn care, and are equal in scope to a typical employer health plan."

I Believe this is saying that ALL policies effective after March 23, 2010 must have these 10 benefit categories added. Maternity and Prescription coverage alone will make every existing non-grandfathered policy premium increase by at least a couple hundred dollars a month.

Even if the sole owner of a policy is male, must maternity coverage still be added? Or, would it be discriminatory to not require that males have maternity coverage?
-ac

The bigger question above ehb's is do they have to also conform to AV values?
Yes all males will have maternity benefits. No gender differences or pricing differences allowed. Only tobacco will pay 50 percent more which could be over$200/mo. Now that's a tax that will make u quit or lie on the app. Cant prove it or not and plan must cover pre-ex

 

[somarco]

Unlimited psych benefits, inpatient and outpatient, including substance abuse.

No problem.

 

[AllenChicago]

The bigger question above ehb's is do they have to also conform to AV values?
Yes all males will have maternity benefits. No gender differences or pricing differences allowed. Only tobacco will pay 50 percent more which could be over$200/mo. Now that's a tax that will make u quit or lie on the app. Cant prove it or not and plan must cover pre-ex

Here's the "Actuarial Value" wording webpage that Blue Cross-IL referenced in this morning's newsletter.
Essential Health Benefits, Actuarial Value, and Accreditation Standards: Ensuring Meaningful, Affordable Coverage | HealthCare.gov

I couldn't open the "AV Calculator" on my laptop. Apparently, it will give you the data you're looking for, YAgents?

Maybe when you get a moment, you can explain why the Actuarial Value calculation is so important. I understand what the 60% (Bronze), 70% (Silver), etc. is referring to, but not why the underlying calculation of these percentages is so important.
-ac