Connector Minimum Creditable Coverage Draft Regulations

1
Connector Minimum CreditableCoverage Draft
Regulations

• July 10, 2008

2
Proposed Changes to Existing Regulations

• Sec. 5.02 Definitions
• Health Benefit Plan includes plans licensed or
  statutorily authorized to operate in states other
  than Massachusetts.

3
Proposed Changes

• Sec 5.02Definitions and Sec. 5.03(2)(h)
• Preventive care provided prior to deductible
• Sets the minimum number of preventive care visits
  that must be provided at either 3 (individual) or
  6 (family) or, alternatively, based upon a plans
  design using national guidelines for preventive
  care.

4
Proposed Changes

• Section 5.03(1)coverage effective dates
• Any health benefit plan will satisfy MCC
  requirements through Dec. 31, 2008, with new MCC
  standards taking effect on Jan. 1, 2009 (or
  later, in one proposed instance).

5
Proposed Changes

• Section 5.03(2)(a)broad range of medical
  benefits
• Provides new guidance on what services, at a
  minimum, are covered by the term broad range of
  medical benefits based on judgments as to the
  appropriate core group of services that a health
  plan should cover.

6
Proposed Changes

• Sec. 5.03(2)aggregating plans
• Makes clear that an individual may combine more
  than one health plan to meet MCC, even if the
  individual components would not, on their own,
  meet MCC.

7
Proposed Changes

• Sections 5.03(2)(j)(2) and (3)(c)high deductible
  health plans
• New requirements that HDHPs must be linked with
  HRAs or HSAs and that the benefits provided for
  in HDHP/HSA-qualified plans must include the
  broad range of medical benefits. Recommended
  date of effect, Jan. 1, 2010.

8
Proposed Changes

• Sec. 5.03(2)(b)plans that do not utilize a
  network of providers
• Clarifies that plans without networks (e.g., an
  indemnity plan) must meet the in-network
  standards set in the MCC regulations.

9
Proposed Changes

• Sec. 5.03(2)(f)annual maximum benefit limits
• Makes clear that limits on services that are not
  considered core services are allowed,
  consistent with most health benefit plans.

10
Proposed Changes

• Sec. 5.02Definitions and 5.03(2)(g)indemnity
  plan
• Permits indemnity plans but requires fee
  schedules to be based on reasonable and customary
  charges or other contractual arrangements between
  providers and health plans.

11
Proposed Changes

• Sec. 5.03(3)other plans meeting MCC
• Health coverage provided by US Veterans
  Administration and provided to Americorps and
  Civilian Community Corps meet MCC.