Final ACA Health Plan Regulations Released

Interim health insurance regulations in effect since the Affordable Care Act’s 2010 enactment—including the requirement that health plans provide internal appeal and external review processes, cover dependent children to age 26, and the prohibition on lifetime and annual benefit limits—were finalized this week. The insurance reforms became applicable six months after the ACA’s enactment, leaving little time for public comment and requiring the regulations to be issued as interim final regulations. Clarifications in the final rules released this week include: plans cannot require dependent children to live in a plan’s service area to be eligible for dependent coverage; states may not impose new filing fee requirements for external review of an adverse coverage determination; states may continue to use existing external review processes that do not fully meet National Association of Insurance Commissioners standards through 2017; and pediatric subspecialists can be designated as a child’s primary care provider. Federal officials also indicated that they are evaluating options for preventing out-of-network providers from balance billing patients when they are treated for emergency services at an in-network hospital. Any changes in the final rules will go into effect beginning 2017.

More than 500,000 Plans Selected in First Week of Open Enrollment

In the first week of the 2015 open enrollment period, nearly 544,000 individuals selected an insurance plan through, according to CMS, an increase of approximately 17% from the number of selections made in the first week of 2014 open enrollment. Thirty-four percent of 2015 plan selections were made by consumers enrolling in a plan for the first time, while the remaining 66% were renewing coverage. The previous year, plan selections were split almost evenly between new and returning enrollees. As noted in a Health Affairsblog, this year’s proportions may reflect that there are fewer people remaining to newly enroll in Marketplace plans and that the message to current enrollees to actively renew is working. To effectuate enrollment, those who have selected a plan must pay their first premium. Further demonstrating a strong first week of open enrollment, more than 3 million users visited and over 1 million applications for coverage were submitted.