Smart Benefits: Start 2015 by Planning for Health Reform Changes in 2016
Monday, December 29, 2014
Key provisions in the proposed rule include:
Annual Open Enrollment Period: The proposed open enrollment period for non-grandfathered policies in the individual market, inside and outside the exchanges, for all benefit years beginning on or after January 1, 2016, would run from October 1 through December 15 of the year prior to the benefit year.
Revised Essential Health Benefits Benchmark Selection: The rule proposes that states select new benchmark plans for 2017, based on plans available in 2014. The current benchmark plans would remain in effect for 2016.
Default Re-Enrollment: Under current rules, consumers who don’t take action during open enrollment are re-enrolled in the same plan they were in the previous year, even if that plan experienced significant premium increases. The notice indicates that states may be able to pursue alternative options for re-enrollment, under which consumers who take no action might be defaulted into a lower cost plan rather than their current plan.
Prescription Drug Coverage: A proposed new drug coverage policy would be based on a pharmacy and therapeutic (P&T) committee system, under which issuers would design their formularies using scientific evidence that would include consideration of safety and efficacy, cover a range of drugs in a broad distribution of therapeutic categories and classes and provide access to drugs that are included in broadly accepted treatment guidelines. As an alternative to, or in combination with, the P&T committee proposal, comments are being accepted on whether another drug count standard based on the American Hospital Formulary Service should be used, or the current USP drug count should be retained.
Cost-Sharing Restrictions: The proposed rule includes several requirements applicable to cost-sharing, including that non-calendar year plans must adhere to the cost-sharing limits effective for the year in which the plan begins and can’t reset cost sharing requirements at the end of the calendar year.
2016 User Fees: The user fee collected from participating issuers to fund federally-facilitated exchange operations was set at 3.5 percent of the monthly premium charged by the issuer for 2014 and 2015. Based on enrollment and premium projections, the proposed user rate fee for 2016 would remain the same.
Maximum Annual Limitation on Cost Sharing: For 2016, the proposed maximum annual limitation on cost sharing would be $6,850 for self-only coverage, and $13,700 for other than self-only coverage.
The proposed rule is available here.
Related Slideshow: Massachusetts Business Rankings
See how Massachusetts stacked up.
Massachusetts has 2015's 28th highest insurance premium penalties for high risk drivers, according to a WalletHub report.
Mass is behind Colorado and New Mexico who come in at 26 and 27 spots respectively while Mass is ahead of Tennessee and the District of Columbia who rank 29 and 30 respectively.
Massachusetts ranks 14th overall in the category of DUI conviction annual premium increase with an amount of $756.
Massachusetts ranks 20th overall in the category of speeding over 20 mph annual premium increase with a total of $261 while ranking 21 overall in the category of two accidents annual premium increase with a total of $1,364.
Massachusetts has been ranked as the 5th most eco-friendly state in the country, according to a recent study by WalletHub.
Mass ranks tenth in environmental quality and fourth in Eco-Friendly Behaviors landing them in 8th overall.
Mass is behind Minnesota and New York who are in the fourth and third spots respectively, and in front of Washington and New Hampshire who come in at the six and seven spots.
Small Business Friendliness Grade: D+
The Economist grades states on an A+ to F grading scale for its small business climate. Massachusetts ranks near the bottom of the nation, joining New Mexico and New York in receiving D+ grades. 9 states scored worse than a D+ in the Economist rankings.
Overbearing bureaucracy and excessive licensing is stifling small business in America.
Forbes ranks each state in business costs, economic climate, and growth prospects.
The most damning in the commentary:
Massachusetts’ business costs, including labor, energy and taxes, are the highest of the 48 contiguous states—only Hawaii is higher—at 20% above the national average.
ChiefExecutive.net ranks each state in taxations and regulations, workforce quality, and living environment.
The most damning in the commentary:
Taxation and regulation are always the key barometers. Massachusetts and Oregon are the worst.
ALEC ranks each state in economic performance and outlook.
Although Massachusetts ranked low in economic performance, a forward-looking forecast is based on the state’s standing in 15 important state policy variables. Some of these variables include top marginal personal income tax rate and sales tax burden.
#18 Free Enterprise
Free Enterprise ranks each state in performance, exports, innovation + entrepreneurship, business climate, talent pipeline, infrastructure.
Massachusetts's reputation as a hotspot for science and technology endures in this year's rankings. The commonwealth is a center for STEM jobs and university research and development, ranking 4th and 2nd, respectively, in those two categories. It also ranks 6th as a center for high-tech establishments. Massachusetts is taking aggressive steps to bolster economic activity with high-impact university-industry R&D projects and new tools for tech-based startup companies.
The Pew Charitable Trusts
#45 The Pew Charitable Trusts
The Pew Charitable Trusts ranks each state in job growth and job creation.
Massachusetts added 38,368 jobs in 2014.
- Smart Benefits: New IRS Publication Tells Individuals if They’ll Pay an ACA Penalty at Tax Time
- Smart Benefits: Popularity of HSAs Continues to Rise
- Smart Benefits: Are Skinny Plans Becoming a Big Draw?
- Smart Benefits: Two Regs Issued on Contraceptive Coverage
- Smart Benefits: Remember to Provide SBCs at Open Enrollment – or Pay
- Smart Benefits: IRS Releases Draft Forms for ACA Reporting
- Smart Benefits: 2015 Health Insurance Rates Approved
- Smart Benefits: IRS Issues Final Regulation on Small Business Tax Credit
- Smart Benefits: Despite Reform Mandate, Birth Control Coverage Ruled Optional
- Smart Benefits: FMLA to Revise Definition of Spouse
- Smart Benefits: Patient-Centered Outcomes Research Institute Fee Due July 31
- Smart Benefits: Are Double-Digit Premium Increases a Thing of the Past?
- Smart Benefits: Is Your Wellness Program EEOC-Proof?
- Smart Benefits: Serve Up Wellness for the Holidays
- Smart Benefits: Employers Can’t Pay for Purchase of Employees Individual Health Insurance
- Smart Benefits: Transitional Reinsurance Enrollment Count Deadline Extended to Dec. 5
- Smart Benefits: Hardship Exemptions from Individual Mandate Published
- Smart Benefits: Consumerism Continues
- Smart Benefits: Supreme Court Will Hear Health Insurance Subsidy Challenge
- Smart Benefits: November 15 Key for Individual – and Employer – Health Exchange Enrollment
- Smart Benefits: New IRS Guidance on FTE Look-Back Period
- Smart Benefits: Obamacare Exchanges: Enrollment Expectations
- Smart Benefits: When Dental and Vision Don’t Count…Under PPAC, That Is
- Smart Benefits: Deadline Next Week for Health Plan Identifiers
- Smart Benefits: CMS Issues Proposed Rule on Definition of Spouse