Smart Benefits: CMS Proposes Improvements for Marketplace
Monday, November 30, 2015
CMS’ recently proposed annual Notice of Benefit and Payment Parameters for 2017, which governs participation in the exchanges, aims to improve the experience for consumers when shopping for insurance – and using it.
The Notice includes several proposed policy changes that would apply to coverage available to consumers in 2017, including:
• Provider Network Adequacy Standard: To protect access to healthcare providers and delivery organizations in light of a broad shift toward narrow provider networks, CMS is proposing asking states to establish a provider network adequacy standard for plans in the federal marketplace, subject to minimum criteria established by CMS.
• Standardized Options: To make it easier for consumers to compare plans based on key provisions, CMS is proposing to give issuers the choice to offer plans with standardized options such as cost-sharing along with other plans with more variable plan designs so consumers can more easily choose the plan that’s right for them.
• Out-of-Pocket Costs: To reduce surprises, CMS is proposing a requirement that health plans in the federal marketplace count certain out-of-pocket expenses on unexpected out-of-network services towards a policy holder’s annual out-of-pocket maximum if they were performed in-network and advance notice wasn’t provided. For example, if a patient had surgery at an in-network facility and later learns the anesthesiologist wasn’t part of the health plan’s network, cost-sharing charges for the anesthesiologist’s services would count toward the out-of-pocket maximum.
CMS is seeking comment on these and many other proposals in the Notice, details of which can be found here.
Rob Calise is the Managing Director, Employee Benefits. of Cornerstone|Gencorp , where he helps clients control the costs of employee benefits by focusing on consumer driven strategies and on how to best utilize the tax savings tools the government provides. Rob serves as Chairman of the Board of United Benefit Advisors, and is a board member of the Blue Cross & Blue Shield of RI Broker Advisory Board, United HealthCare of New England Broker Advisory Board and Rhode Island Business Healthcare Advisors Council. He is also a member of the National Association of Health Underwriters (NAHU), American Health Insurance Association (AHIA) and the Employers Council on Flexible Compensation (ECFC), as well as various human resource associations. Rob is a graduate of Bryant University with a BS in Finance.
Related Slideshow: 20 Cool Small Businesses in RI
Related Articles
- Smart Benefits: IRS Releases ACA Taxpayer Data for 2014
- Smart Benefits: Draft 2015 Forms Released for ACA Reporting
- Smart Benefits: New OHIC Standards to Improve Health Care Delivery
- Smart Benefits: Delaware Says No to State Exchange
- Smart Benefits: Is Your Package Competitive? What’s New in Employee Benefits
- Smart Benefits: SHRM Study Shows More Benefits Offered to Employees
- Smart Benefits: Fines Now In Effect for Small Business Health Plan Reimbursements
- Smart Benefits: Preventive Services Requirement Clarified
- Smart Benefits: Healthy Self” Campaign Highlights Preventive Services
- Smart Benefits: PCORI Fees Due July 31 for Some Employers
- Smart Benefits: Feedback on Next Essential Health Benefits Benchmark Plan Due June 30
- Smart Benefits: 2016 Health Insurance Rates Approved
- Smart Benefits: File 2014 Taxes—or Risk Losing Subsidy
- Smart Benefits: Benefits Increasingly Key to Recruitment
- Smart Benefits: Small Businesses Remain Those with 50 or Less Employees
- Smart Benefits: Important Reminders for 2016 Exchange Open Enrollment
- Smart Benefits: Year-End ACA Tax Tip for Employers
- Smart Benefits: Retirement Plan Contribution Limits Remain Unchanged for 2016
- Smart Benefits: Safe Harbor for Online Insurance Policies Ends Nov. 1
- Smart Benefits: Veterans Exempt from Employee Count Under ACA
- Smart Benefits: New IRS Notice Issued on Cadillac Tax
- Smart Benefits: Determine Independent Contractor vs. Employee for ACA Compliance
- Smart Benefits: Prepare for Open Enrollment Season
- Smart Benefits: IRS Posts ACA Compliance Resource for Large Employers
- Smart Benefits: Private Employers Offer Loan Repayment to Attract Young Workers
