NJ State Updates - 2015 Jan 19 No.01

On May 4, 2015, Commissioner of Insurance Kobylowski issued Bulletin No. 15-04. The bulletin addresses an amendment to New Jersey’s minimum standards for health benefit plans to facilitate “bronze” plan designs consistent with federal requirements.

As background, PPACA requires health benefit plans issued in the individual and small employer markets to satisfy specific actuarial value (AV) standards. The AV calculator proposed by the federal government for 2016 generally produces higher AVs than the AVs calculated using the current (2015) calculator. The 2015 to 2016 calculator change has caused New Jersey health carriers to claim that the “bronze” plans, or plans that must fall within the 58 to 62 percent AV requirement under the new Federal 2016 AV calculator, will be particularly challenging given the $2,500 individual network deductible limit as set forth in New Jersey law.

The New Jersey Department of Insurance has taken action to ensure the continued availability of reasonable and understandable bronze plans for consumers on the federal insurance exchange. The Department will permit New Jersey health carriers to use an individual network deductible up to $3,000 for bronze plans offered in the individual and small employer markets. Therefore, New Jersey employers in the small market will, therefore, see bronze plans with individual deductibles up to $3,000.

Bulletin 15-04 »