2015-04-27-奥纬咨询-HHS_2016_Notice_of_Benefit_and_Payment_Parameters_20页_526kb

Summary of HHS Final Notice of Benefit and Payment Parameters for 2016

This document summarizes the key points from the U.S. Department of Health and Human Services (HHS) Final Notice of Benefit and Payment Parameters for 2016, published on February 27, 2015. It outlines rules for the individual and small group health insurance markets, risk adjustment, reinsurance programs, and other requirements, without including legal advice or unrelated details.

Key Reforms and Requirements

• Health Insurance Market Reforms: Rules for coverage include defining a "plan" as a specific pairing of benefits and cost-sharing structures, with modifications for uniform changes. Guaranteed availability and renewability are addressed, such as offering special enrollment periods for certain life events.
• Risk Adjustment and Reinsurance: The 2016 risk adjustment fee increased to $0.15 per enrollee per month, and reinsurance parameters changed to an attachment point of $90,000, reinsurance cap of $250,000, and 50% coinsurance.
• Exchange Establishments: Defined changes expand eligibility for SHOP plans to cover former employees. The 2016 open enrollment period begins November 1, 2015, and ends January 31, 2016. Language access requirements and website translation standards for non-English speakers were finalized.
• Health Insurance Issuer Standards: Essential Health Benefits (EHB) package includes a new definition for habilitative services, and issuers must establish Pharmacy and Therapeutics (P&T) committees. Premium adjustment percentages are based on prior-year premium growth, calculated at 8.3% for 2016.

Additional Provisions

• Modifications apply to territories, excluding provisions like guaranteed availability and essential health benefits. The document clarifies enforcement, good faith compliance, and rebates for premium tax credits.