Employers will be particularly interested in the premium adjustment percentage being proposed to index to 1.4408219719 (about 4.6% higher than 2022). This is used to index maximum out-of-pocket cost-sharing for non-grandfathered health plans and to calculate §4980H penalties for applicable large employers (ALEs).
|Annual Out-of-Pocket Maximum for Non-Grandfathered Health Plans
always rounded down to nearest $50, and family always twice the per-person limit
always rounded down to nearest $10
There are a couple more points of interest to employers which may affect 2023 plan designs and claims projections. These two proposals are described in the announcement as follows.
- “The 2023 Payment Notice proposed rule also would explicitly prohibit health insurance issuers from discriminating on the basis of sexual orientation and gender identity.”
- “Additionally, this proposal refines the Essential Health Benefits nondiscrimination policy by requiring issuers to rely on clinical evidence as a basis of the health plan design.”
- “For example, plans could not be designed to burden people managing chronic conditions with inordinately high prescription costs, absent a clinical rationale.”
IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.
This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.