CMS ISSUES ADDITIONAL HEALTH PLAN WAIVERS
On January 6, the Centers for Medicare & Medicaid Services (CMS) announced that it had granted waivers to 1,231 employer-sponsored health insurance plans that will allow them to continue despite their non-compliance with certain requirements of the Patient Protection and Affordable Care Act (PPACA).

Most of the waiver recipients are limited medical benefit (“mini-med”) plans which are usually offered to low-paid, part-time or seasonal employees. The new waivers apply to policies offered by 722 self-insured employers, 417 multi-employer plans, 50 health insurance issuers, 34 union plans, five state-mandated policies and three association plans.

PPACA requires that insurance plans provide minimum annual coverage limits for essential health benefits of $750,000 in 2011, $1,250,000 in 2012 and $2,000,000 in 2013. CMS began offering one-year waivers from these requirements in September 2010. PPACA prohibits annual limits for essential benefits beginning January 1, 2014, at which time most mini-med policies will therefore cease to exist.

HHS REJECTS TWO MORE STATES’ MLR WAIVER REQUESTS
On January 4, the Department of Health and Human Services (HHS) continued its recent trend by denying requests by the Kansas and Oklahoma Insurance Departments that would have given insurers in those states two extra years to meet the medical loss ratio (MLR) requirements mandated by PPACA. In doing so, HHS rejected the states’ claims that the requirements are likely to destabilize the states’ individual health insurance markets.

Insurers whose MLRs fail to meet the minimum PPACA standards must rebate the difference to their enrollees beginning with the 2012 plan year. Large group plans must spend at least 85% of the premium dollar on care and quality improvement activities, and individual and small group plans must meet an 80% standard.

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