Insurance Market Reform

This proposed rule would address various requirements applicable to health insurance issuers, Health Insurance Marketplaces, Navigators, non-Navigator assistance personnel, and other entities under the ACA. Specifically, the rule proposes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Marketplaces.

This document contains final regulations providing guidance to employers that are subject to the shared responsibility provisions regarding employee health coverage enacted by the Affordable Care Act. These regulations affect large employers, those with 50 or more full-time employees, including full-time equivalent employees, during the prior year. Generally, an applicable large employer that, for a calendar month, fails to offer health coverage that is affordable and provides minimum value to its full-time employees may be subject to an assessable payment if a full-time employee enrolls for that month in a qualified health plan for which the employee receives a premium tax credit. These employers will need to begin complying with these regulations in 2015.

This document contains proposed regulations relating to the ACA requirement to maintain minimum essential coverage. It stipulates that while certain types of Medicaid coverage and military health programs do not qualify as minimum essential coverage, individuals enrolled in these programs will not be subject to the shared responsibility payment for 2014. This proposed rule also provides more detail on hardship exemptions and enrollment in employer-sponsored health insurance plans.

This final rule establishes the annual fee that will be imposed on health insurers, HMOS, self-insured Multiple Employment Welfare Arrangements (MEWAs), and entities that provide coverage under Medicare Parts C and D and Medicaid beginning in 2014. This health insurance tax is intended to help fund the insurance coverage expansion under the ACA.

This proposed rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also proposes additional standards with respect to composite rating, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, etc.