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HHS Issues Rules on PPACA Exchanges

Posted in Plan Administration, Welfare Plans

While not directly impacting employers, it is important to note that the latest stage of implementation of PPACA involves defining health insurance exchanges.  The Department of Health and Human Services (HHS) has issued "implementing regulations"  that finalize some of the proposed rules addressing the creation and operation of these exchanges.

These final regulations address the creation and eligibility for the state exchanges.  By way of background, the exchanges are ideally the marketplaces that provide the "qualified health plans" that satisfy the minimum benefit standards. These plans would then be open to employers and individuals.

Some of the key components of the final rules:

  1. Exchanges must provide and maintain a  website that contains information about available qualified health plans.  This includes displaying a summary of benefits coverage for each qualified health plan offered..
  2. The regulations include requirements about the content, form and timing requirements for notices sent by an exchange to individuals and employers.  They must be in writing and provided electronically when possible and include the date the notice was sent and the reason for any intended action.
  3. Exchanges must determine and articulate the eligibility for enrollment in a qualified health plan.  Exchanges must allow individuals to enroll in or change from one qualified health plan to another, even outside of the open enrollment period if certain things occur, such as marriage, birth or adoption, 
  4. For dental plans, they must allow limited scope dental benefit plans that satisfy certain coverage requirements to be offered through the exchange.  A dental plan can be offered as a stand-alone dental plan or in conjunction with a qualified health plan.  Cost-sharing limits and restrictions on annual and lifetime limits defined under PPACA apply to stand-alone dental plans for coverage of pediatric dental essential health benefits.

The rules are designed to provide some initial explanation of how the exchanges will be formed and how they will work.  Ideally, employers could review these rules to find out what they should offer as a competitive plan and how it might be measured against an exchange.  However, the real impact may be simply to give insurance companies a clearer framework for developing their qualified health plan offerings.  Certainly more guidance is anticipated but at least we do know that the exchanges are moving forward in case employers choose that as an option.