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Zane Benefits Publishes New Information on Actuarial Value (AV)
Date:1/31/2013

the plan for essential health benefits

divided by:

the total expected costs of the "standard" population for essential health benefits

For example, a plan with a 70 percent actuarial value would be expected to pay, on average, 70 percent of a standard population’s expected medical expenses for essential health benefits. The individuals covered by the plan would be expected to pay, on average, the remaining 30 percent of the expected expenses in the form of deductibles, co-payments, and coinsurance.

The exact process for determining a "standard" actuarial value across multiple plans has yet to be finalized. However, HHS has proposed rules governing the calculation of actuarial value.

Proposed Rules for a Standardized Actuarial Value (AV)

According to Zane Benefits’ website, The Department of Health and Human Services (HHS) has provided information on actuarial value standards in several phases:

  •     On December 16, 2011, HHS released a bulletin that outlined an intended regulatory approach for defining essential health benefits, including a benchmark-based framework.
  •     On January 25, 2012, HHS released a list of the largest three small group market products by state, which were updated on July 2, 2012.
  •     On February 17, 2012, HHS further clarified the approach to essential health benefits through a series of Frequently Asked Questions (FAQs)
  •     On February 24, 2012, HHS published a bulletin outlining an intended regulatory approach to calculations of actuarial value and implementation of cost-sharing reductions
  •     On July 20, 2012, HHS published a final rule authorizing the collection of data to be used under the intended process for states to select from among several benchmark options t
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