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2016 Benefit and Payment Final Rule, Consumer & Provider Provisions
Timothy Jost, in Health Affairs ForefrontLink to more items from this source
[Guidance Overview]
Feb. 22, 2015

"The preface notes that CMS has become aware of benefit designs that discourage enrollment based on age or health condition and that this is prohibited, even if the benefit design is based on a state's benchmark plan.... The final rule clarifies that health plans may refuse to count out-of-network charges toward cost-sharing limits but are not required to do so. Cost-sharing for out of network services does not count toward actuarial value calculations, however."

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