Non-Standardized Plan Option Limits
In 2024 Payment Notice, HHS introduced a limitation on the number of non-standardized plan options as HHS believed the number of plan offerings was overwhelming for consumers with indistinguishable differences. They were permitted four (4) non-standardized plan options per product network type (as described in the definition of ‘‘product’’ at § 144.103), metal level (excluding catastrophic plans), inclusion of dental and/or vision benefit coverage. [22]
This was limited to two (2) non-standardized plan options for plan year 2025, however, HHS explained they failed to distinguish dental between pediatric and adult dental, so additional non-standardized can consider these separate categories. Additionally, HHS indicated further non-standardized plans can be available if they have “specific design features that would substantially benefit consumers with chronic and high-cost conditions and meet certain other requirements,” which typically means lower cost-sharing for certain services or drugs. Table 13 illustrates the plan variations.
Consistent with the clarification provided in the 2025 Payment Notice, HHS proposes an issuer may offer additional non-standardized plan options for each:
- product network type,
- metal level,
- inclusion of adult dental benefit coverage,
- pediatric dental benefit coverage, and/or
- adult vision benefit coverage
Additional plans for specific chronic and high-cost conditions will continue to be able to be offered if an issuer demonstrates: “that these additional plans’ cost sharing for benefits pertaining to the treatment of chronic and high-cost conditions (including benefits in the form of prescription drugs, if pertaining to the treatment of the condition(s)) is at least 25 percent lower, as applied without restriction in scope throughout the plan year, than the cost sharing for the same corresponding benefits in the issuer’s other non- standardized plan option offerings in the same product network type, metal level, inclusion of adult dental benefit coverage, pediatric dental benefit coverage, and/or adult vision benefit coverage, and service area.”
[22] D. Part 156—Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges – 7. Non-Standardized Plan Option Limits (§156.202)