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HHS Notice of Benefit and Payment Parameters for 2015

HHS Notice of Benefit and Payment Parameters for 2015

This HHS rule, issued in March 2014, addresses a number of Marketplace and private insurance issues related to federally-run insurance exchanges, financial assistance, and the operation of the SHOP for small businesses. Among the issues included are:

  • Open enrollment dates for 2015 and beyond (changed from November 15, 2014 to January 15, 2015 for the 2015 plan year; remains October 1- December 7 for all future years).
  • The deadline, which has been extended to June 15, for states to submit a blueprint to transition from a federally facilitated or partnership marketplace to a state-based marketplace for the next plan year.
  • Federally facilitated marketplace policies, including meaningful difference standards to make plans distinguishable to consumers and the user fee for participating insurers (which will remain unchanged at 3.5 percent of premium revenues for 2015).
  • Issues related to cost-sharing, such as: methodology for determining out-of-pocket caps for cost-sharing in 2015 and beyond, updates to the AV calculator, out-of-pocket maximums for stand-alone dental plans, and provisions to ensure that reduced cost-sharing silver plans for people who earn less than 250 percent of poverty do not offer consumers less protection and access to care than silver plans without reduced cost-sharing.
  • Payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs.
  • Updated privacy and security standards regarding consumer information obtained by the marketplace.
  • Issues related to SHOP marketplace enrollment and employer contributions.