Actuarial Value (AV) Calculator
The Department of Health & Human Services (HHS)/Centers for Medicare & Medicaid Services (CMS) built this Actuarial Value (AV) Calculator to assist issuers with calculating the network liability for a given plan design. It primarily will be used by health plans and insurance companies to help them determine the actuarial value for 2014 non-grandfathered small group and individual health plans in and out of the state Marketplace (Exchange). However, some brokers have requested it so we have added it for your convenience.
Actuarial Value, or AV, is calculated as the percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an AV of 70 percent, on average, a consumer could expect to be responsible generally for 30 percent of the costs of all covered benefits in that plan. Beginning in 2014 the plan metal tiers based on actuarial value will be as follows (within a margin of +/- 2%): Platinum – 90%, Gold – 80%, Silver – 70% and Bronze – 60. The purpose of metal tiers is to give consumers a way to compare plans with similar levels of coverage; which, along with premium, provider network and other factors, help the consumer make an informed decision
Tab 1: User Guide
Tab 2: AV Calculator
Tab 3: Platinum Plans (Medical Only) Continuance Table
Tab 4: Gold Plans (Medical Only) Continuance Table
Tab 5: Silver Plans (Medical Only) Continuance Table
Tab 6: Bronze Plans (Medical Only) Continuance Table
Tab 7: Platinum Plans (RX Only) Continuance Table
Tab 8: Gold Plans (RX Only) Continuance Table
Tab 9: Silver Plans (RX Only) Continuance Table
Tab 10: Bronze Plans (RX Only) Continuance Table
ACTUARIAL VALUE (AV)
Minimum Value (MV) Calculator
The Department of Health & Human Services (HHS)/Centers for Medicare & Medicaid Services (CMS) designed this Minimum Value (MV) Calculator to give an estimate of network liability for a given plan design. This MV Calculator can be used to determine if a plan covers at least 60% of the total allowed cost of benefits.
If the plan does not meet this Affordable Care Act (ACA) minimum requirement, the applicable large employer could be subject to an Employer Shared Responsibility Fee/Assessable Payment (i.e. penalty) if even one full-time employee (average 30 hours per week/130 hours per month) receives a premium tax credit or cost-sharing reduction (i.e. subsidy) from the state’s Individual Marketplace (Exchange).
Applicable large employers have 50 or more full-time (FT) plus full-time equivalent (FTE) employees. To calculate the number of FTE employees, total the number of hours worked by all part-time employees (working less than an average of 30 hours per week/130 hours per month) and divide by 120. Our Group Size Calculator will help you with this calculation each month of your Standard Measurement Period.
An HHS report issued in 2011 indicated “…approximately 98% percent of individuals currently covered by employer-sponsored plans are enrolled in plans that have an actuarial value of at least 60 percent …” (IRS Notice 2011-31). Therefore, we do not anticipate this minimum value (60%) requirement will be a problem for the majority of your applicable large employers.
Tab 1: User Guide
Tab 2: MV Calculator
Tab 3: MV Continuation Table – Medical Only
Tab 4: MV Continuation Table – RX Only
Tab 5: MV Continuation Table – Combined Medical and RX