🏥Marketplace Integrity and Affordability Regulations Overview
Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability
Summary
This final rule revises standards relating to denial of coverage for failure to pay past-due premium; excludes Deferred Action for Childhood Arrivals recipients from the definition of "lawfully present;" establishes the evidentiary standard HHS uses to assess an agent's, broker's, or web-broker's potential noncompliance; revises the Exchange automatic reenrollment hierarchy; revises standards related to the annual open enrollment period and special enrollment periods; revises standards relating to failure to file and reconcile, income eligibility verifications for premium tax credits and cost-sharing reductions, annual eligibility redeterminations, de minimis thresholds for the actuarial value for plans subject to essential health benefits (EHB) requirements, and income-based cost-sharing reduction plan variations. This final rule also revises the premium adjustment percentage methodology and prohibits issuers of coverage subject to EHB requirements from providing coverage for specified sex-trait modification procedures as an EHB.
Agencies
- Health and Human Services Department
Business Impact
$$$ - High
This regulation impacts business by revising premium payment policies and eligibility verification standards which could affect health insurance providers' operational processes and financial planning. Changes include the ability for issuers to require payment of past-due premiums before providing new coverage, and stricter rules on eligibility for advance premium tax credits (APTC), which may influence consumer enrollment patterns.