Individual Market Stabilization

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The following Update provides an overview of the final regulations to stabilize the individual and small group markets issued on April 13, 2017.

Final Regulations

The Department of Health and Human Services (HHS) issued final regulations on April 13, 2017 regarding the stabilization of the individual and small group markets.

The final regulations are effective on June 19, 2017 and do not vary significantly from the proposed regulations issued earlier this year in February.  The regulations do not impact large groups, rather they are intended to provide greater flexibility to both states and insurance carriers as well as give enrolling individuals more coverage choices and options.

The Final Regulations Include:

Shorter Open Enrollment Period

The new 2018 Open Enrollment Period for individuals enrolling will be from November 1, 2017 through December 15, 2017 to align more so with open enrollment period for Medicare and the private market.

More Choice

Beginning with 2018 plans, insurance carriers will have greater flexibility to offer more low-cost choices and to continue to offer their existing plan design options for individuals.

Premium Collection

Insurance carriers will be allowed to collect unpaid premiums for past coverage within the year before allowing individuals to re-enroll in order to promote Continuous Coverage.

Special Enrollment Period Control

The final regulations expand verification of eligibility for Special Enrollment Periods in the Marketplace.  This limits the ability of Marketplace individual enrollees to be able to change plan metal levels during the coverage year.  In addition, it adjusts requirements for Special Enrollment Periods due to marriage.

Network and Plan Design

CMS will pass oversight of network access and health plan certification to the states that have adequate review processes to determine network access for their residents.

To learn more about the final regulations, please click on the final regulations or the CMS news article for more details.

ADDITIONAL INFORMATION

Information contained in this Important Updates—In The Know & How It Applies is not intended to render tax or legal advice. Employers should consult with qualified legal and/or tax counsel for guidance with respect to matters of law, tax and related regulations. Creative Benefits & Insurance Solutions provides comprehensive benefits advice and administrative services with respect to all forms of employee benefits, risk management, property & casualty, workers’ compensation, staffing insurance and human resources services. For additional information about our services, please contact us at (586) 992-0404 or email us at service@cbis-lc.com.

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