On October 27, 2017, the Department of Health and Human
Services (HHS) issued proposals which reflect the current administrator’s
desire to improve access to plans on the Exchange, increase competition, and
reduce some of the premium increases affected by the ACA provisions.
Most notably, the proposal allows states to select a
benchmark plan from among these three sources:
- Choose another state’s 2017 benchmark plan. This
allows state’s with a more generous benchmark to choose from among benchmark
plans in every state, and apply those benefits to their own state’s plans.
- Replace one or more EHB categories of benefits
under its current 2017 benchmark plan with another state’s benefits of the same
category. This allows states to cherry-pick their benefit standards.
- Select a new benchmark plan from among a set of
‘typical employer plans’. The new benchmark plan need be no more generous than
the most generous of a set of comparison plans. The proposal defines ‘typical
employer plan’ as a product with substantial enrollment, with at least 5,000
enrollees, or a self insured group health plan with 5,000 or more enrollees. The
state is required to demonstrate the value of each benefit in the benchmark
plan by providing an actuarial analysis to the HHS. This specific provision may
have the greatest impact on the plans offered through the exchange where states
have selected this method of determining their benchmark plans, as many large
group and self insured plans provide less of the essential health benefits than
those of the state exchanges.
As a reminder, the ACA is still law, and employers are
required to deliver 1095 C forms to employees by January 31, 2018. E-filing
with the IRS is due by March 31, 2018. Please contact your dedicated service
associated for assistance and advice when completing the forms.
