Now that you’ve enrolled in a health plan through NY State of Health, you may have some questions about how to use your health plan coverage. Here are some resources with answers to the questions you may have:
On December 7, 2012, the U.S. Department of Health and Human Services (HHS) issued a proposed rule on benefit and payment parameters for 2014. This proposed rule provides further detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for a Federally facilitated Exchange; advance payments of the premium tax credit; a Federally facilitated Small Business Health Option Program; and the medical loss ratio program. Comments were due by December 31, 2012.
On November 27, 2012, the U.S. Department of Health and Human Services (HHS) issued a request for information to seek public comments regarding health plan quality management in Exchanges. Comments were due by December 27, 2012.
On November 26, 2012, the U.S. Department of Health and Human Services issued a proposed rule on health insurance market rules and rate review. This proposed rule would implement the Affordable Care Act’s (ACA) policies related to fair health insurance premiums, guaranteed availability, guaranteed renewability, risk pools, and catastrophic plans. The proposed rule would clarify the approach used to enforce the applicable requirements of the ACA with respect to health insurance issuers and group health plans that are non-federal governmental plans.
On November 26, 2012, the U.S. Department of Health and Human Services issued a proposed rule on standards related to essential health benefits, actuarial value, and accreditation. This proposed rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value.
The NYS Health Benefit Exchange submitted a series of documents to HHS in advance of the state's in-person design review scheduled for October 9th and 10th in Bethesda, MD. The sections covered during the design review correspond with requirements of the State's Exchange Blueprint Application for Exchange Certification due November 16, 2012. A copy of the Blueprint application can be found here.
This report was prepared by Milliman, Inc. This report identifies the issues around the selection of the essential health benefits (EHB) benchmark and discusses the implications that the EHB choice will have on consumers, businesses, and the state. The report examines the implications of the EHB choice on mandated benefits and the policies offered to the individual and small group markets both in and out of the exchange.
On June 28, 2012, New York submitted a Level One application for the federal Exchange Establishment grant. The State received an award of $95.5 million for this grant on August 23, 2012. New York received a supplemental award of $19 million for this grant on September 20, 2013.