On April 9, 2018, the US Department of Health and Human Services (HHS) released the final 2019 Benefit and Payment Parameters Rules (BPP or final Rules). As has been the case with past BPP Rules, the 2019 final Rules address wide ranging issues under the Affordable Care Act (ACA) relevant to Exchange operations, the individual and small-group insurance market, SHOPs, Exchange navigators, and rate review. Certain BPP changes directly impact larger group health plans and employer plan sponsors.
Cost Sharing Limits
The final Rules confirm ACA cost-sharing limits for essential health benefits under non-grandfathered plans for 2019. The maximum annual out-of-pocket limit on cost-sharing for 2019 is $7,900 for self-only coverage and $15,800 for other than self-only coverage. Notably, these increases are based on the “premium adjustment percentage,” which is also used to adjust employer Pay or Play penalty amounts. For 2019, the premium adjustment percentage will increase by 1.125 percent.