HHS Issues Notice of 2015 Benefit and Payment Parameters – Final Rule

On March 5, 2014, the Department of Health and Human Services (HHS) released its notice of the 2015 Benefit and Payment Parameters Final Rule. The final rule describes benefit payment parameters applicable to the 2015 benefit year and standards.

Within the rule, payment parameters are defined as it relates to premium stabilization programs, as well as establishing the Exchange’s open enrollment period for 2015. The ruling also exempts certain self-insured, self-administered plans from the reinsurance fees for 2015 and 2016, as well as updates the cost sharing limits for non-grandfathered plans for 2015.

Among other provisions, the final benefit payment parameters rule implements patient safety standards for qualified health plans (QHPs) offered in the Exchange, and includes standards related to the employee choice and premium aggregation provisions in federally facilitated Small Business Health Option Programs  (SHOPs).

Beginning in 2014, the ACA requires a three-year transitional reinsurance program to be established in each state. This program is intended to help stabilize premiums for coverage in the individual market during the first three years of Exchange operation (2014 through 2016) when individuals with higher-cost medical needs gain insurance coverage. This program will impose a fee on health insurance issuers and self-insured group health plans.

As it specifically relates to open enrollment period for 2015, the benefit payment parameter rule finalizes the Exchange’s annual open enrollment period which will begin on November 15, 2014, and extend through February 15, 2015. According to HHS, this schedule gives issuers additional time before they need to set their 2015 rates and submit their QHP applications, gives states and HHS more time to prepare for open enrollment, and gives consumers until February 15, 2015 to shop for coverage. The rule does not change the schedule for the Exchange’s initial open enrollment period, which began on October 1, 2013 and extends until March 31, 2014.

For cost sharing limits, the final benefit payment parameter rule establishes the final limits for 2015, which are lower than the limits HHS originally proposed.


Final Cost Sharing limits for 2015:

  • The annual deductible for a health plan in the small group market may not exceed $2,050 for self-only coverage and $4,100 for family coverage.
  • The annual out-of-pocket maximum for all health plans is $6,600 for self-only coverage and $13,200 for family coverage.

For assistance in navigating the benefit payment parameters, call Alltrust (727-772-4200) to speak to our Compliance and Healthcare Reform Experts. To read the full article in Alltrust’s Health Care Reform Bulletin, click here.


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