Now you know why 

Read the following. Does it make sense, it is clear and easy to understand? Do you think you might need a lawyer or other specialist to help figure it all out? You are probably right. Welcome to the world of Obamacare regulations. This is just a very small sample of the thousands of pages of regulation that insurers, employers and health care providers must deal with every day. And one more question, do you think all this adds to to the cost of providing health benefits? 😎

Uniform Modification and Plan/Product Withdrawal FAQ

June 15, 2015

Q1: An issuer stops offering Product X at the end of 2015, and in 2016 begins offering Product Y. Is Product Y a new product?

It depends. If the differences between Product X and Product Y qualify as a uniform modification of coverage, then, for purposes of federal law, Product Y is not a new product. Rather, it is a continuation of Product X (even if a new Product ID has been assigned by the issuer), and it should be reviewed as if it is the same product, including with respect to rate review. Only if the changes are outside the scope of changes contemplated by the uniform modification rules would, for purposes of federal law, Product X be considered to have been discontinued, and Product Y be considered a new product. HHS guaranteed renewability regulations at 45 CFR 146.152, 147.106, and 148.122 set forth standards for uniform modifications of coverage and discontinuation of a product (as defined in 45 CFR 144.103).1

For example, Issuer offers Product X in the individual market in 2015 (Product ID: 39854QQ042). Issuer stops offering Product X effective at the end of 2015, and, for 2016 coverage, begins offering Product Y (Product ID: 39854QQ043). The only changes between Product X and Product Y are cost-sharing changes to maintain metal tier levels for each Plan in the Product. For purposes of federal law, Product Y is not a new product because the changes satisfy the conditions of a uniform modification of coverage2– they are cost-sharing changes made to a plan to maintain the same metal tier level.

The uniform modification rules give issuers substantial room to adjust product portfolios. Changes to covered benefits, outside of those made pursuant to applicable federal or state requirements, may cumulatively impact the plan-adjusted index rate for any plan within the product by ±2 percentage points without falling outside the scope of the uniform modification of coverage rules.

In addition, under 45 CFR 147.106(e)(4), regulators may broaden standards relating to service area and cost-sharing structure, giving issuers room to adjust plans within products, and stay within the parameters for 1 HHS regulations at 45 CFR 146.152, 147.106, and 148.122 contain parallel provisions relating to guaranteed renewability of coverage and the exceptions for uniform modification of  …. 😜