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    29 Pdfsam AAHCA BillText 071409

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    Anonymous VRG5peRat
    The document discusses cost-sharing limits for essential health benefits. It states that annual out-of-pocket costs for an individual cannot exceed $5,000 and for a family cannot exceed $10,000 in year one, with these amounts increasing annually based on inflation. It also notes that copays rather than coinsurance should be used when establishing costs for basic, enhanced, and premium health plans to the maximum extent possible. Finally, it indicates that cost-sharing under essential benefits must be designed to meet a minimum actuarial value.

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    29 Pdfsam AAHCA BillText 071409

    Uploaded by

    Anonymous VRG5peRat
    12 views1 page
    The document discusses cost-sharing limits for essential health benefits. It states that annual out-of-pocket costs for an individual cannot exceed $5,000 and for a family cannot exceed $10,000 in year one, with these amounts increasing annually based on inflation. It also notes that copays rather than coinsurance should be used when establishing costs for basic, enhanced, and premium health plans to the maximum extent possible. Finally, it indicates that cost-sharing under essential benefits must be designed to meet a minimum actuarial value.

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    The document discusses cost-sharing limits for essential health benefits. It states that annual out-of-pocket costs for an individual cannot exceed $5,000 and for a family cannot exceed $10,000 in year one, with these amounts increasing annually based on inflation. It also notes that copays rather than coinsurance should be used when establishing costs for basic, enhanced, and premium health plans to the maximum extent possible. Finally, it indicates that cost-sharing under essential benefits must be designed to meet a minimum actuarial value.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    12 views1 page

    29 Pdfsam AAHCA BillText 071409

    Uploaded by

    Anonymous VRG5peRat
    The document discusses cost-sharing limits for essential health benefits. It states that annual out-of-pocket costs for an individual cannot exceed $5,000 and for a family cannot exceed $10,000 in year one, with these amounts increasing annually based on inflation. It also notes that copays rather than coinsurance should be used when establishing costs for basic, enhanced, and premium health plans to the maximum extent possible. Finally, it indicates that cost-sharing under essential benefits must be designed to meet a minimum actuarial value.

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    of 1

    29

    services (as specified under the benefit standards), 1


    including well baby and well child care. 2
    (2) ANNUAL LIMITATION. 3
    (A) ANNUAL LIMITATION.The cost-shar- 4
    ing incurred under the essential benefits pack- 5
    age with respect to an individual (or family) for 6
    a year does not exceed the applicable level spec- 7
    ified in subparagraph (B). 8
    (B) APPLICABLE LEVEL.The applicable 9
    level specified in this subparagraph for Y1 is 10
    $5,000 for an individual and $10,000 for a 11
    family. Such levels shall be increased (rounded 12
    to the nearest $100) for each subsequent year 13
    by the annual percentage increase in the Con- 14
    sumer Price Index (United States city average) 15
    applicable to such year. 16
    (C) USE OF COPAYMENTS.In establishing 17
    cost-sharing levels for basic, enhanced, and pre- 18
    mium plans under this subsection, the Sec- 19
    retary shall, to the maximum extent possible, 20
    use only copayments and not coinsurance. 21
    (3) MINIMUM ACTUARIAL VALUE. 22
    (A) IN GENERAL.The cost-sharing under 23
    the essential benefits package shall be designed 24
    to provide a level of coverage that is designed 25
    VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
    July 14, 2009 (12:51 p.m.)
    F:\P11\NHI\TRICOMM\AAHCA09_001.XML
    f:\VHLC\071409\071409.140.xml (444390|2)

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