United Benefit Advisors Insight and Analysis Blog

Proposed Benefit Payment and Parameters Rule Released

By Danielle Capilla, Senior VP of Compliance and Operations, United Benefit Advisors
  Dec 21, 2015 2:51:50 PM

Person giving money to other personFederal agencies have released the proposed rule for the 2017 Benefit Payment and Parameters. Among other items, it provides updates and annual provisions relating to:

  • Risk adjustments, reinsurance, and risk corridors programs
  • Cost-sharing parameters and cost-sharing reductions
  • User fees for Federally-Facilitated Exchanges (FFEs)
  • The standards for open enrollment for the individual market for the 2017 benefit year
  • Updates to the Small Business Health Options Program (SHOP)
  • Definitions of large and small employer
  • Guaranteed availability
  • Medical loss ratio (MLR) program

The Benefit Payment and Parameters rule is typically finalized in the first quarter of the year following the release of the proposed version. Comments on the proposed rule are due by December 21, 2015 (today).

The proposed rule would set cost sharing for the 2017 calendar year for self-only coverage at $7,150 and $14,300 for other than self-only coverage. The 2017 open enrollment period would be from November 1, 2016, to January 31, 2017.

The proposed rule suggests amending the regulatory definitions of "large" and "small" employers to match the definition set by the Protecting Affordable Coverage for Employees Act (PACE Act). The definitions would be revised to define a large employer as one that averages at least 51 employees in the previous year, but states may elect to define large employers as those with 101 or more employees. Similarly, the definition of small employer would change to an employer with an average of at least one but not more than 50 employees on business days during the preceding calendar year. States may elect to define a small employer as one with 100 or fewer employees. The rule would also provide that, for an employer not in existence the preceding calendar year, its size should be determined by its reasonable expectation of the average number of employees during the year.

Download UBA’s ACA Advisor for additional detail on proposed rules related to:

  • The rating area for a small group plan
  • Availability of small group coverage based on employer contribution or group participation rules
  • Standards of conduct for agents and brokers
  • Special enrollment periods
  • Employer appeals of an employee's eligibility
  • "Vertical choice" options

Topics: ACA, small business health options program, small group insurance, Affordable Care Act, federally-facilitated exchange, risk adjustments, cost-sharing parameters, medical loss ratio