1 / 15

Minimum Creditable Coverage Regulations October 17, 2008

Minimum Creditable Coverage Regulations October 17, 2008. Agenda. Overview of Proposed Revisions to MCC Preventive Care HDHP/HSA Broad Range of Medical Benefits Actuarial Equivalence Collectively-Bargained Plans Technical Corrections Parking Lot Issues Next Steps. Context.

maya
Download Presentation

Minimum Creditable Coverage Regulations October 17, 2008

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Minimum Creditable Coverage Regulations October 17, 2008

  2. Agenda • Overview of Proposed Revisions to MCC • Preventive Care • HDHP/HSA • Broad Range of Medical Benefits • Actuarial Equivalence • Collectively-Bargained Plans • Technical Corrections • Parking Lot Issues • Next Steps

  3. Context • Establish floor for “real” coverage • Protect consumers • Minimize # of tax-payers penalized, despite having “real” coverage • Minimize ERISA concerns • Consider enforcement ability • Learn as we go and “pace” rate of change • Recognize DOI’s complementary role

  4. Preventive Care(effective 1/1/2009) • Add definition of what constitutes “preventive care” • Amend regulations to allow plans to meet pre-deductible preventive care requirement if benefits are comparable to preventive care guidelines adopted by MHQP or if plan covers 3/6 preventive care visits pre-deductible

  5. HDHP/HSA(effective 1/1/2010) • Underlying health benefit plan must include broad range of medical benefits and pre-deductible preventive care requirements • Deductible and out-of-pocket maximums based on federal regulations • Plan sponsor or carrier must provide access to health savings account (HSA)

  6. 1/1/2009 Preventive and Primary care Emergency services Hospitalization Ambulatory services Rx Mental health and substance abuse 1/1/2010 Diagnostic imaging and screening Maternity and newborn care Medical/surgical care Radiation therapy and chemotherapy Broad Range of Medical Benefits

  7. Broad Range of Medical Benefits(effective 1/1/2010) • Benefit limits may be applied, but plan will not meet MCC standards if: • Limitations are clearly inconsistent with standard employer-sponsored coverage; and • Limitations do not represent innovative ways to improve quality or manage the utilization or cost of services delivered

  8. Actuarial Equivalence(effective 1/1/2009) • For “near misses,” carrier or plan sponsor may request Connector certification of MCC compliance if: • Health benefit plan covers core services and broad range of medical benefits; • Benefit limitations are consistent with MCC requirements; and • Plan of benefits has an actuarial value equal to or greater than Connector’s Bronze-level offering

  9. Collectively-Bargained Plans(effective 1/1/2009) • Connector may, at its discretion, determine that a collectively-bargained plan -- in force as of 1/1/2009 -- is compliant with MCC for up to one year following the expiration of the collectively-bargained agreement • Add definition for “multi-employer health benefit plan”

  10. Technical Corrections(effective 1/1/2009) • Clarify that a health benefit plan may not include an overall limit on core services, individually or collectively, per year or per illness • Clarify that separate prescription drug deductible is an option, not a requirement, and that drugs may be included under global deductible • Eliminate regulatory language regarding alternative Rx design

  11. Technical Corrections(effective 1/1/2009) • Out-of-pocket maximum intended to include “covered services,” not just “core services” • Clarify that out-of-pocket maximum includes the amount of the deductible, even if plan documents indicate O-O-P max does not include deductible • Clarify regulatory language pertaining to indemnity fee schedule

  12. Technical Corrections(effective 1/1/2009) • Clarify that a plan sponsor may use a health reimbursement account (HRA) to cover the gap between a health plan’s deductible and MCC’s deductible limits • Clarify that aggregation of multiple benefit plans (e.g., Rx carve out, MH-SA carve out) may be used to meet MCC

  13. 1/1/2009 Preventive care Actuarial equivalence Collectively-bargained plans Technical corrections 1/1/2010 Expansion of broad range of medical benefits Benefits limits standards HDHP/HSA Summary of Effective Dates

  14. Parking Lot Issues • Set floor for plans with lifetime benefits maximum • Expand list of core services • Require an out-of-pocket maximum for all health benefit plans, not just those with overall deductible and/or co-insurance on core services • Set specific minimum limits on broad range of medical benefits • Other?

  15. Next Steps

More Related