Insurers will have to include hospital benefits in all exchange plans

Insurers won't be able to keep excluding hospital benefits in plans sold on the health insurance exchanges if a proposal from the U.S. Department of Health and Human Services (HHS) becomes final, reported Kaiser Health News.

In the proposed rule issued last week, HHS seeks to close a perceived loophole under the Affordable Care Act caused by an online calculator that determines whether plans meet ACA minimum benefit requirements.

The calculator let plans omit inpatient hospital benefits for plans provided through large, self-insured employers. These plans typically have no deductibles for doctor visits and prescriptions, very inexpensive co-payments and emergency room visits that cost between $250 and $400, FierceHealthPayer previously reported.

The new standards would apply to companies with at least 50 employees and require them to "provide substantial coverage of both inpatient hospital services and physician services" to comply with the ACA's minimum benefits.

"A plan that excludes substantial coverage for inpatient hospital and physician services is not a health plan in any meaningful sense and is contrary to the purpose" of the minimum-value standard, HHS said in the proposed rule.

HHS also said it would allow employers to continue offering calculator-approved plans that exclude hospital coverage next year if they already committed to them. Employees would still be able to receive subsidies for those plans if they choose to enroll in them.

"Minimum value is minimum value," Timothy Jost, law professor at Washington and Lee University, told KHN. "Nobody ever imagined that minimum value would not include hospitalization services."

Changes to the minimum value rule would go into effect as soon as the proposed rule becomes a final rule, according to the JD Supra Business Advisor. Minimum value plans put into place prior to Nov. 4 would not be affected before the end of their plan year, while those enacted after Nov. 4 would have to be changed. This "unnecessarily" punishes employers who waited for guidance from HHS before signing contracts, JD Supra said.  

To learn more:
- read the Kaiser Health News article
- read the JD Supra Business Advisor report