HealthCare.gov Notices New Class of Individual Employer Policies

That underwriting process meant that, if an employer sent workers to buy their own coverage, workers with obesity, diabetes, cancer or health conditions would have no way to use the cash to buy coverage.

Starting in 2014, the ACA prohibited health insurers from considering applicants’ health problems when reviewing applications for individual major medical coverage.

After 2014, the main obstacle to letting workers have cash to buy their own coverage was the concern that letting employers send workers in the individual market could destabilize the individual market, the group market or the entire market.

ICHRAs

Regulators shrugged off those concerns in 2019 and completed final regulations for the individual coverage health reimbursement arrangement.

Insurers and benefits brokers were ramping up efforts to market ICHRAs in 2020, around the same time that the COVID-19 pandemic rolled in, absorbed employers’ attention and blocked efforts to hold the kinds of in-person meetings needed to explain new health benefits program.

This year, brokers and employers appear to be poised to give ICHRAs more attention.

Other ACA Provisions

CMS also:

Scaled back special enrollment period verification requirements.

HealthCare.gov and other exchanges try to spur younger, healthier people to sign up for coverage by making it easy to sign up only during an annual open enrollment period.

The idea is that limits on when people can sign up will encourage young people to buy coverage and pay premiums when they can, to avoid breaking a bone or getting into a car accident at a time when buying health coverage is impossible.

Instead, CMS says, it found that the people who made the effort to show that they qualified for special enrollment periods during the ACA off season were sicker than the average applicant, and that tough verification requirements hurt the overall quality of off-season enrollees.

CMS says it will continue to require people who say they are eligible for off-season enrollments because of loss of other coverage to verify that they have actually lost their previous coverage

A majority of off-season enrollees cite loss of coverage as the reason they are applying through special enrollment period provisions, CMS says.

Kept HealthCare.gov out of the market for benefits other than major medical insurance and stand-alone dental plans. The state- run exchanges in some states have experimented with selling products such as ICHRAs and vision insurance, and running ads from for-profit companies on their websites.

CMS noted, in a letter to 2023 issuers that came out with the parameters document, that HealthCare.gov will not display information life insurance policies, disability insurance policies, stand-alone vision plans or other products.

Held plan user fees steady. Insurers in states where HealthCare.gov provides comprehensive services will pay a rate equal to 2.75% of premiums per year.

Chiquita Brooks-LaSure (Photo: CMS)