Plan Management, Rate Filing and Rate Review Process
Reduce Solvency Risk
HHS is soliciting comment on methodologies that can reduce the risk of issuer insolvencies,[16] of which there have been several in recent years including Friday Health Plans and Bright Health Plans. Suggestions included coordinating with State DOIs and the National Association of Insurance Commissioners (NAIC) to identify issuers at risk, ie by looking at significant enrollment growth for new carriers, RBC ratios[17] or quick ratios.[18] HHS is soliciting comment on other methodologies.
Silver Loading
Silver loading refers to a premium load applied to silver metal plans to reflect that the federal government is not longer funding the cost-sharing reduction (CSR) plans.
HHS codified that CSR loading practices that are “permitted by State regulators are permissible under Federal law to the extent that they are reasonable and actuarially justified.”[19] This does not appear to be a change to current practices.
Actuarial Value Calculator
CMS propose to only release a single, final version of the AV Calculator, instead of publishing a draft and a final version. Public comments would be implemented into the following year’s AVC. [20]
Standardized Plan Options
Standardized health plans were introduced to “enhance the consumer experience, increase consumer understanding, simplify the plan selection process, combat discriminatory benefit designs that disproportionately impact disadvantaged populations, and advance health equity.”[21]
As with all plans, standardized plan options will require adjustments to continue to be within the allowable AV range as the AV calculator is updated annually. Minor updates (deductibles and maximum out-of-pocket limits (MOOPs)) are proposed to the standardized plan options for PY2026 to keep the plans within the appropriate AV range.
HHS also reintroduced “meaningful difference” by requiring issuers that offer multiple standardized plan options within the same product network type, metal level, and service area to meaningfully differentiate these plans from one another. They indicated differences in product, network, and formulary as “meaningfully different,” similar to the 2017 Payment Notice.
Table 11 and Table 12 post the details of the standardized plan types.
[16] D. Part 156—Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges – 1. Solicitation of Comments—Reducing the Risk That Issuer Insolvencies Pose to the Integrity of the Federally-Facilitated Exchanges
[17] The risk-based capital ratio is defined as the ratio of an issuer’s total adjusted capital to its authorized control level risk-based capital.
[18] The quick ratio is defined as the ratio between quickly available or liquid assets and current liabilities.
[19] D. Part 156—Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges – 3. Silver Loading (§156.80)
[20] D. Part 156—Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges – 5. AV Calculation for Determining Level of Coverage (§156.135)
[21] D. Part 156—Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges – 6. Standardized Plan Options (§156.201)