Self-funded student health plans and state high-risk pool coverage will be considered minimum essential coverage for calendar year 2014, but they will have to get approved by a health insurance exchange to gain such consideration in 2015, under rules from the Centers for Medicare and Medicaid Services
Carrying minimum essential coverage is required for an individual or employee to avoid individual mandate penalties.
The final rules modify health reform guidelines found at 26 U.S.C. Section 5000A, entitled “Requirement to Maintain Minimum Essential Coverage.” They are on public display until being officially published July 1, 2013 (78 Fed. Reg. 15530). They incorporate comments from industry and the public on a Feb. 1, 2013 proposed rule (78 Fed. Reg. 7348).
“Minimum essential coverage” includes employer-sponsored group health plans, as well as government-sponsored programs like Medicare, Medicaid, CHIP and TRICARE.
The final rules add several categories of minimum essential coverage, including refugee medical assistance supported by the Administration for Children and Families and Medicare Advantage plans.
Also added were self-funded student health insurance plans and state high risk pools. However, these entities will get a grace period under which they will be considered minimum essential coverage through 2014 before being required to substantiate the status after Dec. 31, 2014.
The final rules declined to follow an earlier proposal to designate foreign health coverage and AmeriCorps coverage as minimum health coverage. To gain such a designation, such coverage will have to go through a certification process.
The rules also describe which individuals will get an exemption from fines resulting from a failure to carry health insurance for themselves and their non-exempt family members.
See this story for the latest news on health reform’s employer and individual shared responsiblity requirements. Go to the Health Reform Law: What Employers Need to Know for an overview and more than 500 specific questions employers are asking about health reform.