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Society comments influence Health Reimbursement Account changes

Last Thursday, June 13, the US Departments of Health and Human Services (HHS), Labor (DOL) and Treasury (DOT) released their final rule on Health Reimbursement Accounts (HRA). The final rule mostly mirrored what was proposed late last year, with several changes that were influenced by Society comments, including information resources for patients and new limits on short-term limited duration insurance plans (STLDI).

The final HRA rule is the third part of the Trump Administration’s efforts to make regulatory changes to the broader health insurance marketplace – the other two impact association health plans and STLDI. The changes in the final rule include:

  • Expanding how employers can offer their employees HRAs.
  • Clarifying who is eligible for an HRA.
  • Compliance requirements with the Affordable Care Act.
  • Affordability standards.
  • Which types of coverage can be acquired with funds from an HRA (STLDIs, stand-alone dental and COBRA benefits).

The Society commented on several of the provisions of the rule, most notably recommending that HHS and DOL create guidelines to help educate employees who receive HRAs along with side-by-side comparisons of plans, and that STLDI plans not be allowed to be purchased with HRA funds.

Under the new rule and beginning with the 2020 enrollment period, HHS will provide resources for individuals offered an HRA to determine whether an HRA is affordable when compared to their ACA eligibility. This comparison was not in the proposed rule and was created in response to comments citing potential employee confusion and the need for employees to be able to determine affordability as highlighted by the Society and other groups. HHS also restricted the use of HRA funds to purchase STLDI plans, citing concerns about potential adverse selection in the small group health insurance market. The Society has consistently raised concerns, both in current and past comments, about easing restrictions on STLDI plans; citing threats to market stability and inadequate patient coverage. Under the rule HRAs won’t be allowed to reimburse for STLDI premiums if the employer is either fully or partially insured, and if the reimbursement of STLDI premiums causes significant harm to the small group market in a given state.

These rule changes demonstrate the impact of the physician voice and the importance of being engaged at all levels of the policy-making process. The members of the Society’s Innovations in Health Care Task Force were instrumental in developing the comment letters that impacted the rulings.

Please contact HJ Waukau with any questions about the final rule or past comments.

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