The Department of Health and Human Services (HHS) has released its final Notice of Benefit and Payment Parameters for 2019. This final rule describes parameters under the Affordable Care Act (ACA) that apply for the 2019 benefit year.
Standards included in the final rule relate to:
Annual limitations on cost sharing
For 2018 plans, the out-of-pocket maximum is $7,350 for self-only coverage and $14,700 for family coverage. In 2019 the out-of-pocket maximum will increase to $7,900 for self-only coverage and $15,800 for family coverage.
The individual mandate’s affordability exemption
The Tax Cuts and Jobs Act reduced the individual mandate penalty to zero, so beginning in 2019 individuals will no longer be penalized for failing to obtain acceptable health insurance coverage. However, individuals may still need to seek the affordability exemption for 2019 and future years (for example, in order to be eligible for catastrophic coverage). For 2019, an individual qualifies for the affordability exemption if he or she must pay more than 8.3% of his or her household income for minimum essential coverage (MEC).
Special enrollment periods in the Exchange
Under the Exchanges, special enrollment periods (SEPs) are available for those who experience qualifying events. The 2019 final rule establishes a new SEP that allows pregnant women who are receiving health care services through Children’s Health Insurance Program (CHIP) coverage for their unborn child to qualify for a 60-day loss of coverage SEP upon losing access to this coverage.
Essential health benefit (EHB) benchmark plan options
ACA required non-grandfathered plans in the individual and small group markets to offer a core package of services known as essential health benefits (EHB’s), equal in scope to benefits offered by a typical employer health plan. States could select a benchmark plan based on 3 different enrollment statistics for plans in the state or based on the Federal Employees Health Benefits Program. Beginning with the 2020 plan year, the final rule allows states to select a new EHB-benchmark plan on an annual basis, and provides substantially more options for selecting a benchmark plan. In addition, the final rule allows states to maintain their current 2017 EHB-benchmark plan without taking any action.
The final rule eliminates the online enrollment process and allows employers to enroll through a SHOP plan issuer or a SHOP registered agent/broker.
Standardized Exchange Plan Options
The final rule eliminates the standardized plan options in the FFE for the 2019 plan year, due to concern that providing differential display for these plans may limit enrollment in coverage with nonstandardized option plan designs, removing incentives for issuers to offer coverage with innovative plan designs.
Refer to the attached compliance bulletin for detail and contact your NEEBCo representative with questions.
Final 2019 Notice of Benefit and Payment Parameters