United Benefit Advisors Insight and Analysis Blog

Final Rule on Short-Term, Limited-Duration Insurance

Posted by: Karen Hsu    Sep 13, 2018 1:55:19 PM

On August 3, 2018, the Internal Revenue Service, the Department of Health and Human Services (HHS), and the Department of Labor (collectively, the Departments) published a final rule that amends the definition of short-term, limited-duration insurance. HHS also released a fact sheet on the final rule.

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Topics: health insurance, Department of Health and Human Services, Department of Labor, Internal Revenue Service

Final Rule on Short-Term Limited-Duration Insurance

Posted by: Karen Hsu    Aug 23, 2018 1:04:47 PM

On August 1, 2018, the Internal Revenue Service, the Department of Health and Human Services (HHS), and the Department of Labor (collectively, the Departments) released a final rule that amends the definition of short-term, limited-duration insurance. HHS also released a fact sheet on the final rule.

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Topics: health insurance, Department of Health and Human Services, short-term insurance

Reference-Based Pricing and Cost-Sharing Limits

Posted by: Linda Rowings    Nov 11, 2014 10:19:00 AM

The Department of Labor (DOL), the IRS, and the Department of Health and Human Services (HHS) have jointly issued a FAQ that addresses how "reference-based pricing" works with the Patient Protection and Affordable Care Act's (PPACA) restrictions on out-of-pocket maximums. PPACA limits the out-of-pocket maximum a non-grandfathered plan may impose, and generally requires that co-pays, coinsurance, and deductibles be counted toward this limit. However, premiums, balance billed amounts for non-network providers, and non-covered services do not need to be applied to the out-of-pocket limit. (For 2015, the limits are $6,600 per individual or $13,200 per family.) The new FAQ explains how the out-of-pocket limit applies to plans that use reference-based pricing--i.e., a design under which the plan pays a fixed amount for a particular procedure (such as a knee replacement), which certain providers have agreed to accept as full payment.

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Topics: Linda Rowings, IRS, HHS, Reference-Based, Pricing, Cost-Sharing, Limits, Department of Labor, Department of Health and Human Services, DOL