Insurers and Employer Groups Asking for Additional PPACA Transitional Relief


ImageAUGUST 21, 2013 – 11:59 AM


The recent transitional relief from the Employer Mandate issued by the federal government has generated a spate of requests from health insurance associations and employers for additional grace periods and amendments from other significant elements of the Patient Protection and Affordable Care Act (PPACA).

Both the Blue Cross and Blue Shield Association (BCBSA) and America’s Health Insurance Plans (AHIP) have filed comment letters on the proposed rule entitled, Program Integrity: Exchange, SHOP, Premium Stabilization Programs, and Market Standards,published in the Federal Register (78 FR 37031). AHIP requested a one-year delay in federal enforcement of the rules to ensure information technology is working as intended. AHIP is concerned that the additional time may be necessary to ensure the complex IT requirements will function as needed.

BCBSA and AHIP also requested that the Centers for Medicare & Medicaid Services amend the proposed requirement that Qualified Health Plans (QHPs) both inside and outside the Exchange/Marketplace be “substantially the same” in order to participate in the PPACA risk corridors program. Both organizations maintain that the definition of “substantially the same” was issued subsequent to the QHP application filing deadline. The imposition of the “substantially the same” requirement represents a major change in the assumptions under which the QHP filings were made.

On a separate note, a service industry advocacy group, Employers for Flexibility in Healthcare (E-FLEX) Coalition, has requested clarification on how the transitional relief for non-calendar year health benefit plans will apply to the recent, one-year waiver to the Employer Mandate. They are requesting the ability to rely on the transitional reliefs through the 2015 benefit year. The letter was sent to Health and Human Services Secretary Kathleen Sebelius, Treasury Secretary Jacob Lew, Labor Secretary Thomas Perez, and congressional leaders.  

We will continue to monitor these issues and communicate the response as soon as it becomes public.

Author: MIcheael Gomez


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