individual health plans
The Department of Health and Human Services (HHS) issued some new guidance on May 2, 2014 as it relates to Special Enrollment Periods and Hardship Exemptions in the individual marketplace. The new guidance has been summarized below:
Today is the last day of February which means we are only one month away from the end of the first open enrollment period for individual health plans. March 31st is the last day that individuals can sign up for coverage without a qualifying event, but there is one big question that is still looming – Will the open enrollment period get extended to a later date?
- The Department of Health and Human Services (HHS) has reported Exchange application submissions have exceeded 3 million.
- The Congressional Budget Office (CBO) has updated 2014 Exchange enrollment estimates to 6 million.
- Some reports are showing that 22,000 Exchange applicants were enrolled in the wrong plan or received a lower subsidy than expected, 15,000 Exchange applications were lost and only 11% of Exchange applicants were previously uninsured.
Last week, President Obama announced that Americans can keep individual health insurance policies that they were told will be canceled because they failed to meet requirements established by the Affordable Care Act (ACA).
The Affordable Care Act (ACA) requires non-grandfathered plans to impose limitations on out-of-pocket expenses for essential health benefits starting in 2014. The out-of-pocket limitations will be capped next year at $6,350 for single coverage and $12,700 for family coverage.
However, some self-funded plans will be exempt from this requirement until 2015. The guidance indicates that self-funded plans contracting with multiple service providers can delay this requirement for one year.
The U.S. Department of Health and Human Services (HHS) released the final regulations about Essential Health Benefits (EHB) on February 20, 2013. The guidance defines the benefits that must be included with all fully insured plans sold inside and outside of the public exchanges in 2014. This will impact all individual health plans and most small group health plans. Grandfathered plans and self-insured plans are exempt from the EHB requirements; however, self-insured plans that cover any EHB must provide coverage without any annual or lifetime dollar limits.
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