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HHS Releases Proposed 2021 Benefit and Payment Parameters Notice, With Increased Cost-Sharing Limits, New Notice Requirement


· 5 minute read


· 5 minute read

PPACA; HHS Notice of Benefit and Payment Parameters for 2021, Proposed Rule; Notice Requirement for Non-Federal Governmental Plans, 45 CFR Parts 146, 149, 155, 156, and 158, 85 Fed. Reg. 7088 (Feb. 6, 2020); Proposed HHS Notice of Benefit and Payment Parameters for 2021 Fact Sheet


Fact Sheet

HHS has released proposed regulations with the benefit and payment parameters for 2021, along with other insurance market and Exchange-related proposed rules and a proposed notice requirement for non-federal governmental excepted benefit health reimbursement arrangements (EBHRAs). Although largely aimed at insurers and Exchange regulators, some provisions may be of interest to employers and their advisors. Here are highlights:

  • Annual Cost-Sharing Limits. HHS has proposed to increase the maximum annual limitation on cost-sharing for 2021 to $8,550 for self-only coverage and $17,100 for other than self-only coverage (compared to $8,150 and $16,300 for 2020).
  • Drug Manufacturer Coupons. HHS would permit, but not require, plans and insurers to count direct support offered by drug manufacturers to enrollees for specific prescription drugs toward the annual limit on cost-sharing, regardless of whether a generic equivalent is available. HHS would interpret the definition of cost-sharing to exclude expenditures covered by drug manufacturer coupons. [EBIA Comment: Under the 2020 benefit and payment parameters, health plans are not required to count drug manufacturers’ direct support toward the annual limit on cost-sharing when a medically appropriate generic equivalent is available (see our Checkpoint article). According to stakeholders, this provision implied that, in any other circumstances, plans and insurers must count this support toward the annual cost-sharing limits, a requirement that could create a conflict with certain rules for high deductible health plans (HDHPs) that are intended to allow eligible individuals to establish HSAs. In subsequent FAQ guidance (see our Checkpoint article), the agencies acknowledged that HDHP insurers or sponsors may be unable to comply with both rules simultaneously and announced that they intended to address this conflict in the 2021 benefit and payment parameters.]
  • EBHRAs. HHS proposes to require EBHRAs offered by non-federal governmental plan sponsors to provide participants with a notice that is generally consistent with the content of the ERISA summary plan description (SPD). The notice would state conditions of eligibility to receive benefits under the HRA, describe annual or lifetime limits on benefits under the HRA, and provide a summary of the benefits consistent with ERISA requirements. [EBIA Comment: The notice requirement is designed to address comments on recent HRA rulemaking that individuals should receive clear information about their HRAs.]

EBIA Comment: As with the 2020 benefit and payment parameters, HHS has attempted to minimize the number of significant regulatory changes in the 2021 proposals. Although they address a broad range of Exchange and insurance market rules primarily aimed at insurers and Exchanges (including proposed changes for the medical loss ratio (MLR) and risk adjustment rules), employers and their health plan advisors will want to review them. For more information, see EBIA’s Health Care Reform manual at Sections IX.B (“Cost-Sharing Limits”) and V.F (“Excepted Benefits: Certain Health FSAs, Dental, Vision, and Others”). See also EBIA’s Consumer-Driven Health Care manual at Sections X.I (“Effects of Health Care Reform on HDHP Design”) and XXVIII.C (“Excepted Benefit HRAs (EBHRAs)”) and EBIA’s Self-Insured Health Plans manual at Section XI.E (“Trends in Self-Insured Health Plan Design”).

Contributing Editors: EBIA Staff.

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