Benefits Buzz

New Health Insurance Exchange Rules Finalized

Posted on April 18th, 2017

On April 13th, the Centers for Medicare and Medicaid Services (CMS) finalized rules which aim to stabilize Exchanges and the individual marketplace. There are five key takeaways from the new rules:
1. 2018 Open Enrollment Period. The final rule confirms previously proposed guidance which shortens the 2018 open enrollment period to a 45-day window. The next open enrollment period will start on November 1, 2017, and will end on December 15, 2017. Anyone applying for coverage during the open enrollment period will be issued an effective date of January 1, 2018.
2. Special Enrollment Periods. There will be no more honor system when it comes to applying for coverage during a special enrollment period. The Exchange will require supporting documentation to verify a qualifying event did indeed occur. 
3. Unpaid Premiums. Insurance companies will be permitted to collect unpaid premiums from the previous year if an individual wants to enroll in coverage with the same insurance company the following year. This is intended to prevent the number of people who avoid making premium payments during the last few months of the year unless they get sick. 
4. More Plan Choices. The new rule allows more flexibility in achieving actuarial values relative to metallic tier status. In theory, this should allow for more plan choices, but we’ll have to see how many insurance companies continue to participate in the Exchanges and the individual marketplace. 
5. Network Adequacy. States, rather than the federal government, will have the power to determine if plan networks are adequate and have enough doctors and hospitals for individuals to receive medical care.

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