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Small Business Employee Benefits and HR Blog

HHS Releases Proposed Rules on Essential Health Benefits

The U.S. Department of Health and Human Services (HHS) yesterday issued several proposed rules regarding a number of key provisions of the Affordable Care Act. The rules are now subject to comment from interested parties. Read on for an overview of the proposed rules.hhs proposed rules

1. Proposed Rule for Essential Health Benefits, Actuarial Value and Accreditation Standards

This proposed rule details exchange and issuer standards related to coverage of essential health benefits and actuarial value. It also proposes a time line for qualified health plans to be accredited in federally facilitated exchanges and an amendment that provides an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans. The appendix to the proposed rule includes for comment the proposed list of state-selected EHB-benchmark plans, as well as the HHS-assigned default benchmark plans for a state that did not select a benchmark plan. This proposed rule will be open for a 30-day comment period after date of publication in the Federal Register.

Click here to view the proposed rule.

2. Proposed Rule for Health Insurance Market Reforms

This proposed rule addresses the Affordable Care Act's provisions related to pre-existing conditions, underwriting, open and special enrollment periods, health insurance premiums (or rating reforms), risk pools and catastrophic plans. It also proposes amendments to the rate review program in preparation for the market changes in 2014 and to streamline data collection for insurers and states. This proposed rule will be open for a 30-day comment period after date of publication in the Federal Register.

Click here to view the proposed rule.

3. Proposed Rules on Wellness Programs

This proposed rule outlines the standards for health-contingent wellness programs, which can reward employees for meeting specific health targets. The maximum reward under a health-contingent wellness program increases from 20 percent to 30 percent of the cost of employee coverage, and up to 50 percent for programs designed to prevent or reduce tobacco use. This proposed rule will be open for a 60-day comment period after date of publication in the Federal Register.

Click here to view the proposed rule.

 

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