HHS Issues Proposed 2022 Benefit and Payment Parameters

On December 4, 2020, HHS issued the proposed Notice of Benefit and Payment Parameters Rule for 2022. This notice is issued annually and, once final, adopts certain changes for the next plan year. While the proposed rule primarily impacts the individual market and the Exchange, it also addresses certain ACA provisions and related topics that impact employer-sponsored group health plans. Highlights include:

• Annual Cost-Sharing Limits. As background, the ACA requires non-grandfathered group health plans to comply with an out-of-pocket maximum on expenses for essential health benefits. This maximum annual limitation on cost sharing for 2022 is proposed to be $9,100 for self-only coverage and $18,200 for family coverage (an increase from $8,550 and $17,100 for self-only/family coverage respectively in 2021).
• Medical Loss Ratio Rebates . HHS proposes to amend the MLR calculation so that certain defined prescription drug rebates and other price concessions would be deducted from an insurer’s incurred claims beginning with the 2022 reporting year. Additionally, insurers would be permitted to distribute MLR rebates earlier than the date the insurer currently is required to submit their MLR data to HHS (July 31).
• Employer-Sponsored Coverage Verification . As a reminder, employees are not eligible for a premium tax credit in the health insurance exchange if they are offered coverage by their employer that meets the minimum value and affordability standards. Exchanges are not currently required to verify an employee’s statement that they are not eligible for such coverage. HHS proposes to extend the nonenforcement relief for an exchange to conduct random sampling verification through 2022.
• Exchange Special Enrollment Period . HHS plans to clarify that the complete loss of employer contributions toward an individual's COBRA premium would be a special enrollment period permitting the individual to enroll through the exchange program mid-year outside of the annual enrollment period.

Once final, employers should review the regulations and implement any changes needed for their 2022 plan year.

Proposed Rules »
Fact Sheet »