I Need a Quick Answer to My Dumb Question!

NWBenefitProvider

Guru
100+ Post Club
570
I know small group health plans will be adopting the medal standard. However, I have not seen anything in my area discussing if large group plans will also be required to follow the medal standard too? I mean groups of 51+ that curently are underwritten with different components that community rated small groups. Does anyone know if they will also have to choose from medal plans, or will they still have the flexibility tthey do now?

Thanks!
 
The Metal plans (Bronze, Silver, Gold & Platinum) are for the small group and IFP market only. They conform to actuarial values of 60%, 70%, 80%, 90%. As such, they already meet the minimum value (MV) test, and it falls under the broad terminology of MEC (minimum essential coverage). In the small group & IFP market there can also be catastrophic plans for people under age 30, and those who meet the "affordability" exemption.

The large group market does not have metal tiers. They can build their plan designs in a variety of ways. For PPACA, they have 3 goals to hit.

The first is MEC (minimum essential coverage) which is the minimum level of coverage required by PPACA. It can be a very skinny plan that almost resembles last year's mini meds, or it can have higher benefits all the way up to a very rich plan. Offering an MEC plan (whether skinny or rich) to 95% of the full-time employees gets the employer out of the 1st Employer penalty (well, now that penalty is delayed a year!).

MEC is a large umbrella of terminology. Underneath that broad terminology of MEC lies MV (minimum value). This is the 60% actuarial value that is required for a large group to avoid the 2nd Employer penalty (which was also delayed a year).

Of course, the MV plan must also be affordable, according to the 9.5% rule in order to avoid that 2nd penalty.
 
Thank you, Ann! I don't know how you are keeping this all straight. I'm about ready to bring on an assistant to keep things going smooth to free up extra time to stay on top of all this.
 
Thank you, Ann! I don't know how you are keeping this all straight. I'm about ready to bring on an assistant to keep things going smooth to free up extra time to stay on top of all this.

+1! I really do try to stay on top of this stuff, but without some folks on the forum, I would have a hard time interpreting all this.

Ann, YAgents, Timsip, and many others get a nod from me for making me look smarter than I really am.
 
You are quite welcome. I am struggling to keep up with it too, and I likewise appreciate what others post.
 
While Ann is 100% right (and wrote it out extremely well), carriers may brand large-group offerings with metal tiers for conformity sake, or to indicate what the AV of a certain plan is.

Not required, but there is a high chance you'll see it anyway from some carriers. Others, obviously, will not use it in order to differentiate the small/indy and large group product.

I just mention this because I've had a rep state that all product next year will have a metal value, even though we know that designation is not mandatory in LG.
 
I think you are right, Ray. We just got a puppy for our kids, and he came with brochures about Pet Insurance. What a hearty laugh it was when I opened the brochure to see a grid of.......

Bronze Plan
Silver Plan
Gold Plan
Platinum Plan

This made my day!
 
I am sharing a graphic here that I created to try to explain the broad umbrella of Minimum Essential Coverage, and then the standard of Minimum Value (60% actuarial value or more) within MEC, It also shows which segment can buy which plans, and what market (or exchange) they can use to buy it in.

Even if you do not do group insurance, be aware that MEC that is outside the standard of Minimum Value is still important, because if a client ENROLLS IN it, they are not eligible for a subsidy for the month that they enrolled in it. If that coverage is employer-sponsored and it is also minimum value (sometimes called "adequate", at 60% actuarial value or more), and "affordable" (the 9.5% of self-only premium rule), then the person is not qualified for a subsidy whether they enroll in it or not, because they are eligible for it.

So, quick reminder -
1. If it's MEC and they ENROLL IN it, they don't get a subsidy for the months in which they enroll in it.
2. If that MEC is also Minimum Value and Affordable and offered by their employer, they won't get a subsidy at all if they are eligible for it. Doesn't matter if they enroll in it or not.
 

Attachments

  • Desktop MV & MEC.jpg
    Desktop MV & MEC.jpg
    160.6 KB · Views: 26
Back
Top