HHS Releases Proposed Rules on Health Insurance Market Reforms, Essential Health Benefits and Employee Wellness Programs

On November 20, the Department of Health and Human Services (HHS) released three major rules regarding insurance market reforms, essential health benefits and employee wellness programs.  The proposed rules stem from provisions enacted in the Patient Protection and Affordable Care Act (PPACA).

1. The proposed rule on health insurance market reforms touched on the key issues of guaranteed availability, guaranteed renewability, risk pools and catastrophic plans.  These issues included prohibitions against discrimination for pre-existing or chronic conditions while permitting certain premium variances based on age, tobacco use, family size and geography. Review the HHS fact sheet on this proposed rule. Review the proposed rule.

2. The second proposed rule details health insurance standards of coverage for essential health benefits, guidelines for the determination of actuarial value for benefits, and an application process for accreditation of health plans as well as a timeline for when health plans must be accredited.  The rule also included a one month extension of the deadline for states to select an essential health benefits package. Review the HHS fact sheet on this proposed rule.  Review the proposed rule. 

3. The third proposed rule centered on the implementation and expansion of employee wellness programs.  Review the HHS fact sheet on this proposed rule.  Review the proposed rule. 

ASA will be closely reviewing these rules.