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Proposed Standard Plan Design Revision (please submit comments by 1/27/23 to firstname.lastname@example.org)
Following release of the federal proposed 2024 Actuarial Value Calculator, MHBE re-analyzed the standard plan designs recommended by the Affordability Workgroup for 2024.
During the workgroup, the plans’ actuarial value was calculated using the available 2023 AV calculator. Running the plan designs through the recently released 2024 AV calculator yields actuarial values that exceed the federally-allowed maximum AV in the Silver CSR 73% and 94% plans, and the Bronze plan.
In order to try to bring these plans within the allowable AV range, as recommended by the Affordability Workgroup, MHBE first increased the medical and drug out of pocket maximums (MOOP). The federal government sets maximum allowable MOOPs. We increased the Silver CSR 73% and Bronze MOOPs to the maximum allowed levels. This reduced these plans’ AV, but not enough. The CSR 94 plan MOOP can be as high as $3,150 but we achieved what we felt was a reasonable AV by increasing the MOOP to a combined $2,000 ($1,750 medical + $250 drug). This meant only the Silver CSR 73% and Bronze required additional adjustment to bring them into AV range.
MHBE, in consultation with MIA, explored multiple options for further reducing the AVs for the Silver CSR 73% and the Bronze plan. In addition, we made the changes proposed to the Silver 73% plan to the Base Silver plan as well, in keeping with the principle that copays should be the same or higher in plan designs with lower AVs, so as to clearly signal to consumers that lower AV plans typically will result in higher out-of-pocket costs.
Ultimately, we developed two options. The first is to increase the specialist copay in the three plans at issue from $80 to $90, and to increase the generic drug copay from $20 to $25. This is MHBE staff’s recommended option. (Note, MD law states that the copay for a prescription drug may not exceed the retail price of the drug, so if the retail price of a generic drug is less than the $25, the consumer would pay the lower retail price.) The second option shown below is to increase the specialist copay from $80 to $110 in the two silver plans at issue, and to $125 in the bronze plan, and keep the generic copay at the originally proposed $20 in the three plans. We invite comment on these options.
Other changes we considered for these three plans, but that are not proposed because they did not yield sufficient AV reductions on their own, included further increasing the generic drug copay, making X-rays and Diagnostic Imaging and Laboratory Outpatient and Professional Services subject to the deductible, increasing the Primary Care copay to $40, and, for the Silver plans, changing the balance between the drug and medical MOOPs. Ultimately, we feel that the two options we identified best minimize changes to the original plan designs, which were carefully developed by the Affordability Workgroup, and minimize impact to consumers.
Revised standard plan designs
Update (11/21/2022)Proposed 2024 Plan Certification Standards
Update (9/24/2021)Proposed 2023 Plan Certification Standards
Update (9/30/2020) Proposed 2022 Plan Certification Standards
Update (9/13/18)Proposed 2020 Plan Certification Standards
Update (11/27/17)Proposed 2019 Plan Certification Standards.
MHBE hosted three public sessions for comment on the proposed standards:Dec. 7, 2017 | 2-4 p.m. | Plan Management Stakeholder Committee | Maryland Health Benefit ExchangeDec. 14, 2017 | 2-4 p.m. | Standing Advisory Committee | Department of TransportationJan. 4, 2018 | 2-4 p.m. | Plan Management Stakeholder Committee | Maryland Health Benefit ExchangeMHBE released the Draft 2019 Letter to Issuers Seeking to Participate on Maryland Health Connection on Dec. 15, 2017. DRAFT- 2017 Standardized Benefit Design Work Group Report – Incorporated Commentary
Update (12/09/16)DRAFT- 2018 Proposed Plan Certification Standards
Notice of Public Hearing and Intent to Apply for 1332 Waiver Extension
MHBE will hold a public hearing on the 1332 Waiver Extension Application on February 15, 2022, 1:00 – 2:00pm. A draft of the application will be posted here by Wednesday, February 8. Written comments on the draft application will be due by Friday, February 17th.
1332 Waiver Extension Letter of Intent to CMSWaiver Extension LOI Response from CMS
Update (3/1/2022)2023 State Reinsurance Program Estimated ParametersPublic comments will be accepted until March 31 and can be sent to email@example.com.
Update (2/26/21)2022 Estimated State Reinsurance Parameters
Update (6/5/20)Estimated 2021 Reinsurance Payment ParametersProposed “Hybrid” Dampening ApproachDampening Factor ComparisonsSummary of Comments and MHBE Response
Update (4/16/18)Under section 1332 of the Affordable Care Act, states may apply for State Innovation Waivers to waive certain federal requirements with the goal of improving their health insurance markets. During the 2018 legislative session, the Maryland General Assembly passed House Bill 1795 – Establishment of a State Reinsurance Program. Governor Hogan signed House Bill 1795 on April 5, 2018. States are required to post State Innovation Waiver Applications for public comment for a minimum of 30 days.
Update (08/1/19)Draft Affordability Work Group Report
More information on the Affordability Work Group and its progress.
Updated 12/10/2021Draft 2023 Letter to Issuers
Update (1/15/21)2022 DRAFT Letter to Issuers
Update (12/20/19) 2021 Letter to Issuers seeking to participate in Maryland Health Connection.
Update (9/26/19)Proposed 2021 Plan Certification Standards
Update (06/13/19)In the 2020 Final Letter to Issuers Participating on Maryland Health Connection, MHBE was tasked to create a work group to help determine whether the current benchmark plan meets the needs of the individual market. The work group concluded its work on April 26, 2019, and drafted recommendations to be presented to the MHBE Board of Trustees on whether to leverage new state flexibility to modify the State Benchmark Plan. State Benchmark Plan Work Group Draft Report More information about the State Benchmark Plan Work Group and their progress.
Update (02/01/19)MHBE finalized the 2020 Annual Letter to Issuers Seeking to Participate in Maryland Health Connection. We thank all who provided feedback and responses to the Draft.
Update (12/7/18)2020 DRAFT Letter to Issuers
Update (12/15/17)MHBE released the 2019 DRAFT Letter to Issuers.
Update (12/13/16)2018 DRAFT Letter to IssuersMHBE 2018 Plan Certification Proposal – Standardized Benefit Design for Silver and Gold QHPs
Update (4/8/22)The Maryland Health Benefit Exchange has drafted regulatory updates to align the annual open enrollment period with 45 CFR §155.410(e), and to clarify certain SEPs and add new SEPs in compliance with 45 CFR §155.420. The proposed action includes SEPs for the Maryland Health Insurance Easy Enrollment Program in accordance with Md. Code, Ins. §31.202 and for pregnancy in accordance with Md. Code, Ins. §15-1316(c)(2); it also brings COMAR into alignment with Exchange operations.
These updates were finalized as proposed. The draft regulations were published in the Maryland Register and comments were accepted until May 9, 2022.
Update (09/10/21)The Maryland Health Benefit Exchange (MHBE) drafted regulations to set forth the structure, implementation, and eligibility standards for the Young Adult Health Insurance Subsidies Program, as required under Insurance Article, §31-117, Annotated Code of Maryland, as well as alter existing regulations to accommodate the Young Adult Health Insurance Subsidies Program. These updates were finalized as proposed. The draft regulations were published in the September 10, 2021 Issue of the Maryland Register and comments were accepted until October 10, 2021.
Young Adult Subsidy Program Proposed Regulations
Update (07/19/19)The Maryland Health Benefit Exchange (MHBE) drafted regulations that pertain to the Small Business Health Options Program (SHOP). MHBE has authority to regulate these areas under Parts 155 and 156 of Title 45 of the Code of Federal Regulations and Title 31 of the Maryland Insurance Article, Annotated Code of Maryland. The regulations were posted in the July 19th Issue of the Maryland Register.
MHBE previously invited preliminary comments on the draft regulations from key stakeholders. MHBE’s responses to those comments are available here.
Update (11/9/18)The Maryland Health Benefit Exchange (MHBE) drafted regulations that pertain to eligibility and enrollment in a qualified plan through the Exchange, certification to participate on the Exchange as a carrier, and certification to offer a qualified plan for sale on the Exchange. MHBE has authority to regulate these areas under Parts 155 and 156 of Title 45 of the Code of Federal Regulations and Title 31 of the Maryland Insurance Article, Annotated Code of Maryland. The regulations were posted in the November 9th Issue of the Maryland Register.
Update (6/20/16)The MHBE Board of Trustees requested in the Resolution of Board of Trustees Approving Submission of Proposed Amendments to COMAR 14.35.01 and 14.35.07 that MHBE submit the proposed amendments to COMAR 14.35.01.01, COMAR 14.35.01.02 and COMAR 14.35.07 to the Maryland Senate Finance Committee, the House Health, Government and Operations Committee and the Joint Committee on Administrative, Executive and Legislative Review for the Committees’ consideration and for publication in the Maryland Register for a formal public notice and comment period.
Update (5/31/2016) – REVISED CHAPTER 16MHBE reviewed all comments received regarding proposed COMAR 14.35.16 and provided a revised and redlined version of this chapter and a chart that summarizes the comments received. MHBE also provided version 5 of COMAR 14.35.01.02 that incorporates all comments received pertaining to the definitions in general and the specific definitions within Chapters 7, 14-16.
Update (5/24/2016) – REVISED CHAPTER 15MHBE reviewed all comments received regarding proposed COMAR 14.35.15 and provided a revised and redlined version of this chapter and a chart that summarizes the comments received. MHBE also provided version 4 of COMAR 14.35.01.02 that incorporates all comments received pertaining to the definitions in general and the specific definitions within Chapters 7, 14-15.
Update (5/9/2016)MHBE reviewed all comments received regarding proposed COMAR 14.35.14 and provided a revised and redlined version of this chapter and a chart that summarizes the comments received. MHBE also provided a further revised and redlined version of COMAR 14.35.01.02 that incorporates all general comments received pertaining to definitions and a chart that summarizes these comments received.
Update (5/3/2016)MHBE reviewed all comments received by April 27, 2016 regarding proposed COMAR 14.35.07. In advance of the May 12, 2016 public meeting that addressed proposed COMAR 14.35.07, MHBE provided a revised, redlined version of the chapter and a chart that summarizes comments received on this chapter and MHBE’s response. Revisions to COMAR 14.35.01.02 (Definitions) were also shared at and were updated and re-posted as MHBE’s shares revised and redline versions of proposed COMAR 14.35.14-.17 prior to the May 12 and May 17 or 18 meetings.
Additionally, MHBE’s response to comments specifically about MHBE’s approach to implementing federal requirements in state regulations may be found here.
The Maryland Health Benefit Exchange (MHBE) drafted regulations that pertain to eligibility and enrollment in a qualified plan through the Exchange, certification to participate on the Exchange as a carrier and certification to offer a qualified plan for sale on the Exchange. MHBE has authority to regulate these areas under Parts 155 and 156 of Title 45 of the Code of Federal Regulations and Title 31 of the Maryland Insurance Article, Annotated Code of Maryland. MHBE seeks informal public comment on the draft regulations through written comments and two meetings in which both members of the MHBE Standing Advisory Committee (SAC) and non-SAC members may be heard. MHBE accepted written comments on the following draft regulations until April 27, 2016:
The draft chapters are provided with this notice for public review. Any language that MHBE proposes to strike in COMAR 14.35.01.02 and Chapters 7 and 14, which are being repurposed, is indicated with [brackets] and any language that MHBE proposes to adopt is indicated with italics. All language in Chapters 15-17 is new.
In addition, the following meetings of the SAC were held to solicit public comment regarding the draft regulations from SAC members and non-SAC members:
Meeting 1:Date – May 12, 2016; 2-4pm Location – Fred L. Wineland Building, 16 Francis Street, Annapolis, MD 21401 Draft Regulations To Be Covered – 14.35.07, 14.35.14 and 14.35.01.02 (applicable to Ch. 7 and 14)
Meeting 2:Date – May 17, 2016; 1-4pm Location – Fred L. Wineland Building, 16 Francis Street, Annapolis, MD 21401 Draft Regulations To Be Covered – 14.35.15, 14.35.16, 14.35.17 and 14.35.01.02 (applicable to Ch 15-17)
Update (5/25/22)Young Adult Subsidy Proposed Parameters for 2023
Update (4/20/21)Proposed Young Adult Subsidy Pilot Program parameters
Update (10/2/20)MHBE analyzed the potential impact of subsidies on the individual market using the analysis completed by Lewis and Ellis Actuaries and Consultants.
Update (05/10/19)The Maryland Health Benefit Exchange received applications for the Maryland Easy Enrollment Health Insurance Program (MEEHP) Advisory Group. The workgroup was established as required under § 31–203 of the Insurance Article. The advisory workgroup’s input will help the effectiveness of the Maryland Health Insurance Option Easy Enrollment Health Insurance Program and provide recommendations as to whether implementing an individual responsibility amount or implementing automatic enrollment of individuals in a qualified health benefit plan in the individual market is feasible and in the best interest of the state.
Update (02/05/19)MHBE received applications for the 2019 State Benchmark Plan work group and the Affordability work group.
Update (12/20/17)MHBE accepted applications for the 2018 Plan Management Stakeholder Committee (PMSC). The application period ended on January 12, 2018. MHBE Plan Management Stakeholder Committee Charter – 2018 Plan Management Stakeholder Committee Member Application
Update (7/11/17)MHBE added two members to the Standardized Benefit Design Work Group (SBDWG). In the 2018 Final Letter to Issuers Participating on Maryland Health Connection, MHBE was tasked to create a workgroup to help determine the scope of possible standardized benefit design standards, whether it be mandatory or optional, develop draft plans, and provide additional insight. The workgroup will provide recommendations to the MHBE Board of Trustees for 2019 QHP Certification Standards. 2017 Standardized Benefit Design Workgroup Charter Work Group Application
Update (2/6/17)Standardized Plan Committee Application
Update (7/14/16)Chapter 14: MHBE asked the Board of Trustees to consider proposed Chapter 14 at a Board meeting in the fall instead of the July Board meeting. Chapters 15 and 16: Interested parties submitted written comments to MHBE by July 29, 2016 instead of the original due date of July 15, 2016.
Update (6/16/16)MHBE revised the schedule for the MHBE Board of Trustees’ consideration of Chapter 14 and the schedule for written comment and Board consideration of Chapters 15 and 16. The Board was asked to consider proposed Chapter 14 at the July 18, 2016 Board meeting.
Update (5/24/2016) – GENERAL NOTICE of PUBLIC MEETINGS MHBE hosted two additional public meetings to discuss proposed Chapters 15 (Individual Exchange Carrier Certification Standards) and 16 (Individual Exchange QHP Certification Standards). Meeting 1: Date – June 13, 2016 Location – Maryland Health Benefit Exchange, 750 East Pratt Street, 16th Floor, Baltimore MD 21202 Draft Chapter To Be Covered – Chapter 15 Meeting 2: Date – June 14, 2016 Location – Maryland Health Benefit Exchange, 750 East Pratt Street, 16th Floor, Baltimore MD 21202 Draft Chapter To Be Covered – Chapter 16
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