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Health & Welfare Plans Newsletter

April 2, 2024


[Official Guidance]

Text of HHS Final Rule: Notice of Benefit and Payment Parameters for 2025 (PDF)

748 pages. "This final rule includes payment parameters and provisions related to the HHS- operated risk adjustment program, as well as 2025 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to the auto re-enrollment hierarchy; essential health benefits; failure to file Federal income taxes to reconcile advance payments of the premium tax credit (APTC); non-standardized plan option limits in the FFEs and SBE-FPs and a related exceptions process; standardized plan options in the FFEs and SBE-FPs; special enrollment periods (SEPs); direct enrollment (DE) entities supporting Exchange applications and enrollments; the Insurance Affordability Program enrollment eligibility verification process; requirements for agents, brokers, web-brokers, and DE entities assisting Exchange consumers; network adequacy; public notice procedures for section 1332 waivers; prescription drug benefits; updates to the Consumer Operated and Oriented Plan (CO- OP) Program; and State flexibility on the effective date of coverage in the Basic Health Program (BHP)."  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]; and Department of the Treasury

[Official Guidance]

Text of CMS Memo: Final 2025 Actuarial Value Calculator Methodology (PDF)

23 pages. "This document is revised from the 2024 AV Calculator Methodology to incorporate updates to the 2025 AV Calculator. The first part of this document provides background that includes an overview of the regulation that allows HHS to make updates to the AV Calculator as well as the updates that are incorporated into the final 2025 AV Calculator. The second part of the document provides a detailed description of the development of the standard population and the AV Calculator methodology." [Also available: 2025 Actuarial Value Calculator (XLSM)]  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of Tri-Agency ACA FAQs, Part 66: Prohibition on Lifetime and Annual Limits and Annual Limitation on Cost Sharing

"As explained in the preamble to the final 2025 NBPP, the proposed 2025 NBPP primarily addressed the application of this policy with respect to issuers of non-grandfathered individual and small group market plans subject to the requirement to provide EHB. The final 2025 NBPP does not address the application of this policy to large group market health plans and self-insured group health plans. The Departments understand the questions raised by commenters with respect to large group market health plans and self-insured group health plans and intend to address the applicability of this policy to those plans in future notice-and-comment rulemaking."  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Guidance Overview]

HHS Fact Sheet: Notice of Benefit and Payment Parameters for 2025 Final Rule

"Network adequacy ... Allowing states to add routine non-pediatric dental benefits as Essential Health Benefits (EHBs) ... Prescription drug benefits ... Standardized and Non-Standardized Plan options ... EHB-benchmark plan update process improvements ... Special Enrollment Periods ... Effective date of coverage in the Basic Health Program ... State marketplaces to operate a centralized eligibility and enrollment platform on the state marketplace's website ... Annual Open Enrollment dates for state marketplaces not utilizing the federal platform ... Ensure web-brokers and direct enrollment entities operating in state marketplaces neet certain HHS standards applicable in the FFMs and SBM-FPs ... Section 1332 waiver public notice requirements ... FFM and SBM-FP user fees ... Risk adjustment user fee for the 2025 benefit year."  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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