Regulation of Student Health Plans Under Federal and State Law: An Overview
In March of 2012, the U.S. Department of Health and Human Services issued a regulation defining student health plans as individual health insurance under federal law. As a result, they are now subject to the same consumer protections afforded to all those covered by individual health insurance set forth in the Public Health Service Act, as amended by the Affordable Care Act. This issue brief, prepared by the Center on Health Insurance Reforms at the Georgetown University Health Policy Institute, examines student health plans, which cover over 1 million students, and investigates the interplay between federal and state regulation with regard to these plans.
Final HHS Notice of Benefit and Payment Parameters for 2016: Brief Summary of Key Provisions for the 2016 Plan Year
On February 27, 2015, the federal Department of Health and Human Services published the Notice of Benefit and Payment Parameters for 2016 Final Rule, which included several provisions pertaining to form review. This analysis, prepared by the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms, provides a brief summary of the key provisions specific to form review and other notable provisions specific to the 2016 plan year.
A Guide to Meaningful Difference
Federal regulations state that in order to be certified as a Qualified Health Plan in a Federally-facilitated marketplace, plans must be considered “meaningfully different” from all other plans in their subgroup. This document, prepared by the Georgetown Health Policy Institute’s Center on Health Insurance Reforms, is intended to help insurance regulators to understand meaningful difference standards and the ways in which they are applied by CMS.
Short-term, Limited-duration Insurance and Excepted Benefits
Excepted benefits and short-term, limited-duration insurance are insurance products that are exempted from the Affordable Care Act’s (ACA) consumer protections. Recent questions from several states have indicated that some confusion exists about which insurance products qualify as “excepted benefits” and are therefore exempt from several requirements of the ACA, such as coverage for preventive health services, a prohibition on lifetime limits, and minimum value requirements…
Specialty Tier Pharmacy Benefit Designs in Commercial Insurance Policies: Issues and Considerations
As health care costs rise, one of the chief determinants of the rate of increase has been the cost of prescription drugs. Over time, additional tiers have been included in pharmacy benefit designs and, as they were added, cost sharing in the new, higher tiers has increased.
Addressing the Financial Impact of Renewals: Why Many Enrollees Could Benefit from Shopping
As the 2015 open enrollment period approaches, one of the most significant challenges faced by marketplaces stems from the complicated nature of premium subsidy calculations, which may lead to potentially large swings in consumers’ after-subsidy premiums and tax liability implications.
QHP/IAP Renewals Small Group Convening Resources
The State Network hosted a Small Group Convening in Boston, MA on July 10-11, 2014, bringing together state officials and technical experts to discuss QHP and IAP renewals in advance of the upcoming open enrollment period. The meeting provided officials from several states within and outside of State Network an opportunity to discuss strategies for confronting potential issues related to the renewals process.
State Tasks for Partnership Exchange
Manatt Health Solutions, with support from the State Network, has prepared a high level summary of the tasks that states must accomplish to achieve certification of a State Partnership Exchange for Plan Management and/or Consumer Assistance. These tasks closely track the Blueprint for Approval of Affordable State-based or State Partnership Insurance Exchanges, with detailed annotations of tasks directly from the Blueprint.
Analysis of Federal Statutory and Regulatory Eligibility and Enrollment
The following chart, prepared by Manatt Health Solutions, with support from the State Network, summarizes the federal statutory and regulatory eligibility and enrollment requirements for Medicaid using the Modified Adjusted Gross Income (MAGI) methodology, CHIP, Non-MAGI Medicaid, Temporary Assistance for Needy Families (TANF), Child Care Assistance Program and Supplemental Nutrition Assistance Program (SNAP).
HHS Proposed Rules on Exchange Implementation Requirements
Health insurance exchanges are the vehicle through which millions of Americans will gain access to coverage beginning in 2014. The U.S. Department of Health and Human Services (HHS) released its initial proposed rules on exchange implementation on July 11, 2011.