Bookmark and Share

January 2015 St@teside

New Resources for Departments of Insurance on Expected Benefits and Reference Pricing

Short-term, Limited-duration Insurance and Excepted Benefits

Excepted benefits and short-term, limited-duration insurance are insurance products that are exempted from the Affordable Care Act’s (ACA) consumer protections. Recent questions from several states have indicated that some confusion exists about which insurance products qualify as “excepted benefits” and are therefore exempt from several requirements of the ACA, such as coverage for preventive health services, a prohibition on lifetime limits, and minimum value requirements. This issue brief, prepared by the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms with support from the State Health Reform Assistance Network (State Network), provides a framework of the federal law governing requirements for identifying both “short-term, limited-duration” insurance and “excepted benefits,” walking through the categories of excepted benefits and discussing particular product types in detail.

Reference Pricing: An Overview and Suggested Policy Considerations

Reference pricing is intended to reduce medical costs both for insurers and for purchasers of health care services, encouraging enrollees to obtain services from lower-cost providers and motivating higher cost providers to lower their reimbursement rates for those same services. This issue brief, which also was prepared by the Georgetown Health Policy Institute’s Center of Health Insurance Reforms with support from the State Network, provides an overview of this pricing method and federal guidance that has been issued to date. There are a number of factors that state and federal regulators should consider when reviewing plans that apply the pricing method, which are summarized in the issue brief, along with other policy considerations.

For additional resources related to the Affordable Care Act and insurance market reforms, visit the State Network’s website.