Proposed 2017 Benefit and Payment Parameter Notice

Late Friday afternoon, shortly after the FEHBlog hit post on Friday’s message, HHS issued its proposed ACA benefit and payment parameter notice for 2017 which clocks in at 381 pages.  This rule principally provides guidance to qualified health plans in the exchanges but some of the guidance  extends to plans outside the exchanges including FEHB plans.  Here are links to the HHS fact sheet ,  Professor Tim Jost’s initial column on the annual rulemaking, and even a Washington Post article.

With respect to provisions that do apply to the FEHBP, the notice proposes  (p. 215)that the “2017 maximum annual limitation on cost sharing would be $7,150 for self-only coverage and $14,300 for other than self-only coverage.”  For 2016, “The maximum out-of-pocket limit for self-only coverage is $6,850 (up from $6,600 in 2015). For coverage other than self-only (such as family coverage), the maximum out-of-pocket limit is $13,700 (up from $13,200 in 2015).”  The maximum applies to deductibles, copayments and coinsurance but not premiums or out of network provider charges.

The notice (p. 275-76) also proposes to end the transitional reinsurance program after 2016 as it must.  The transitional reinsurance program requires most FEHB plans to contribute to a fund to help finance the QHPs in the exchanges.

The public comment deadline on this notice is December 21, 2015.  HHS typically finalizes this rulemaking in the winter months.