Reform Reminder: What are Benefit Metal Levels?

Starting in 2014, all non-grandfathered health plans in the individual and small group markets (both inside and outside of the exchanges) must provide coverage that meets certain distinct levels of coverage. The levels of coverage are called benefit “metal levels” and are based on the actuarial value (AV) of the plan.

 

To determine the AV of a health plan, the U.S. Department of Health and Human Services (HHS) developed an AV calculator using a set of claims data reflecting the population expected to enroll in the individual and small-group markets in 2014.

 

To ensure a consistent methodology for determining AV, all health plans will be required to use the HHS AV calculator for 2014, although plans with unique benefit designs that are not accommodated by the calculator can make appropriate adjustments, which must be certified by an actuary.

 

Although “Catastrophic” is not a “metal” plan, it is an option for those under the age of 30 at the beginning of the plan year and to those who are certified by the exchange as exempt from the individual mandate.

 

If you have more questions about benefit levels, please contact your Health Net representative.

 

 

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Susan Peters