Zane Benefits Publishes New Information on HHS Ruling and Health Care Reform

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Final Rule on HHS Notice of Benefit and Payment Parameters Expands Upon Standards Set Forth in Earlier Rules.

Today, Zane Benefits, Inc. published new information on health care reform. Zane Benefits, which provides comprehensive and flexible alternatives to traditional employer sponsored health benefits, is the leader in defined contribution and health reimbursement arrangements.

According to Zane Benefits’ website, on March 1st, 2013, the federal government issued a final rule on the HHS Notice of Benefit and Payment Parameters. The HHS Notice of Benefit and Payment Parameters final rule expands upon the standards set forth in earlier rules and provides further information on the following topics:

1. Permanent risk adjustment,
2. Transitional reinsurance program,
3. Temporary risk corridors program,
4. Advance payments of the premium tax credit and cost-sharing reductions,
5. Small Business Health Options Program (SHOP), and
6. Medical Loss Ratios (MLRs).

1. Permanent risk adjustment

According to Zane Benefits’ website, the permanent risk adjustment program will assist health insurance plans that provide coverage to individuals with higher risk populations, such as those with chronic conditions, and will reduce the incentives for issuers to avoid enrolling only healthy individuals.

States that are running a Health Insurance Marketplace and their own risk adjustment program can propose their own methodology for risk adjustment. HHS is finalizing the risk adjustment methodology the agency will operate when a state chooses not to run its own. The final rule also provides a framework for the agency's approach to validating risk adjustment data.

2. Transitional reinsurance program

According to Zane Benefits’ website, the transitional reinsurance program is a three-year program designed to reduce premiums and ensure market stability by helping issuers cover the costs of high-risk enrollees in the individual market.

The statute sets a fixed contribution amount for the reinsurance program. To improve efficiency and reduce administrative burden, the final rule finalizes uniform reinsurance payment parameters for this program and provided States the flexibility to supplement these payment parameters with additional contributions.

3. Temporary risk corridors program

According to Zane Benefits’ website, the temporary risk corridors program is designed to protect against uncertainty in rate setting for qualified health plans by limiting the extent of issuer losses and gains.

The final rule finalizes additional technical details on how issuers will account for profits and taxes in their risk corridors calculations, which align this program with the medical loss ratio program.

4. Advance payments of the premium tax credit and cost-sharing reductions

According to Zane Benefits’ website, to help eligible individuals pay their premiums and make coverage purchased through a Health Insurance Marketplace affordable for low- and middle-income consumers, HHS is finalizing its proposal to make advance payments of the value of cost-sharing reductions and the mechanisms for determining the amount of the advance payment of the premium tax credit to issuers on behalf of eligible individuals.

HHS is also finalizing its proposal that issuers provide cost-sharing reductions at the point of service for eligible individuals and that HHS directly reimburse issuers for the value of these reductions.

5. Small Business Health Options Program (SHOP)

According to Zane Benefits’ website, HHS is finalizing a number of provisions to provide qualified health plan options for small businesses.

These provisions help to ensure a competitive market in the small business health options program (SHOP). Separately, HHS published a proposed rule outlining a transitional policy for certain operations of the SHOP to ensure market stability in 2014 and conforming SHOP special enrollment periods to those in the broader group health insurance market.

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About Zane Benefits
Zane Benefits was founded in 2006 to provide a revolutionized SaaS (Software-as-a-Service) administration platform ("ZaneHRA") for Health Reimbursement Arrangements (HRAs) and defined contribution health care. The flagship software provides a 100% paperless administration experience to employers and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, visit

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Christina Merhar
Zane Benefits
800-391-9209 6725
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