Insights

CMS Issues Final Market Stabilization Rules


On April 13, 2017, CMS issued the final regulations related to Market Stability. The rules included few changes from the proposed rules issued in February 2017, which were summarized in the Feb. 22, 2017 edition of Compliance Corner.

Special Enrollment Periods: Beginning in June 2017, individuals enrolling in a federally facilitated exchange through a special enrollment period (such as loss of eligibility for other coverage, birth, marriage, release from incarceration and change in residence) will be required to go through a pre-enrollment verification process before coverage is effective. Applications will be pended until the individual submits documentation (within 30 days). State-based exchanges are encouraged, but not required, to use the verification process. Specific to the special enrollment period for marriage, in order to enroll in the individual market, at least one spouse must demonstrate prior minimum essential coverage or that he/she lived in a foreign country for one or more days during the 60 days preceding the marriage date.

Exchange Open Enrollment Period: For the 2018 coverage year, the open enrollment period in the exchange will run from Nov. 1, 2017, to Dec. 15, 2017. This is a change from past years when enrollment was permitted through January.

Guaranteed Availability: Under the guaranteed availability rules, an insurer must accept any new application for coverage during the open enrollment or special enrollment periods. Under the final rules, if an individual or employer owes past premiums within the last 12 months to an insurer or a member of the insurer’s controlled group, the insurer may collect the debt before effectuating the new coverage. This rule applies in the individual, small group and large group markets both on and off the exchange.

Metal Levels: Non-grandfathered individual and small group policies are currently categorized into four metal levels based on their actuarial value (AV): bronze (60 percent AV), silver (70 percent AV), gold (80 percent AV) and platinum (90 percent AV). A policy must be within +/- two points of the metal level. To encourage flexibility and the design of new plans, the actuarial value of policies will be determined using a -4/+2 points beginning Jan. 1, 2018.

Final Rules »