Dive Brief:
- The Department of Health and Human Services has issued proposed rules that would forbid group health plan designs that don't provide coverage of inpatient hospital services.
- The new standard articulated in the rules would require companies with at least 50 workers to offer "substantial" coverage of both inpatient hospital and physician services to meet the ACA's "minimum value" threshold for the employer mandate.
- HHS is offering the proposed rules, in part, because as things stand, employees with this less-robust coverage would not be allowed to get subsidies to buy richer marketplace coverage.
Dive Insight:
Large employers don't have to offer the "essential health benefits" ACA exchange plans must offer, which means that they don't have to offer key options such as hospitalization, physician care and prescriptions. But if they want to avoid per-worker surcharges of up to $3,120, their plan must meet the minimum value standard set by the ACA.
The problem is that the official online "calculator" for deciding whether a plan has met the minimum-value standard has been approving plans without inpatient benefits.
To work things out, HHS has proposed granting temporary relief to companies that had already committed to calculator-approved plans without hospital coverage for 2015. (By 2016, however, no plan would meet the minimum-value requirement without offering inpatient benefits.) Meanwhile, workers at these companies would become eligible for premium subsidies if they choose to buy plans there.