DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare Actuarial Value Calculator Methodology
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چکیده
In the Essential Health Benefits, Actuarial Value, and Accreditation Notice of Proposed Rulemaking published in the Federal Register, HHS proposes the use of an AV Calculator to determine levels of coverage for non-grandfathered health insurance plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges). Section 1302(d)(2)(A) of the Affordable Care Act stipulates that AV be calculated based on the provision of essential health benefits (EHBs) to a standard population. The statute groups health plans into four tiers: bronze, with an AV of 60%; silver, with an AV of 70%; gold, with an AV of 80%; and platinum, with an AV of 90%. The Notice of Proposed Rulemaking proposes that a de minimis variation of +/2% of AV is allowed for each tier.
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