June 8, 2007 In This Issue Health Connector Board Approves Regulations Defining Minimum Creditable Coverage Health Care Reform Tool for Employers Affordability Regulations Approved, Waivers Ruling Postponed Resources Commonwealth Health Insurance Connector 1-877-MAENROLL bluecrossma.com Health Connector Board Approves Regulations Defining Minimum Creditable Coverage On June 5, the Connector Board approved regulations defining minimum creditable coverage (MCC) that will go into effect on January 1, 2009. We are currently assessing the full impact of these regulations on our products and accounts and will keep you informed of our progress and changes to our plans throughout the summer. Under these regulations, a comprehensive health plan must include preventive and primary care, emergency services, hospitalization benefits, ambulatory patient services, mental health services, and prescription drug coverage pursuant to the applicable state and federal regulations governing the plan. Insurance plans cannot impose an annual or per illness maximum benefit or an indemnity fee schedule for benefits. The revised regulations clarify that the ban on annual benefit caps only applies to core services such as in-patient acute care services, day surgery, and diagnostic procedures. Maximum out-of-pocket spending for in-network services would be capped at $5,000 for individual coverage and $10,000 for family coverage when there is an annual deductible or co-insurance. The deductible must be capped at $2,000 for individuals and $4,000 for families. Provided that there is a separate drug coverage deductible, it may not exceed $250 for individuals and $500 for families. A revision to the regulations appears to now allow employer contributions to an HRA to be combined with a high deductible plan to meet the deductible maximum standard. Although employers are required to offer insurance or pay a penalty under the law, they do not have to offer coverage that meets the new standards. It is up to the individual to have coverage that meets MCC or be subject to the applicable penalty. Blue Cross Blue Shield of Massachusetts worked with the Connector staff and provided input on the draft regulations and some of these comments were reflected in the final version. However, in general, the Connector staff and board decided not to make significant modifications to the regulations because of the many interrelated decisions they had previously reached unanimously. Click on the links to download the final MCC regulations and the board’s memo regarding the proposed regulatory changes. Health Care Reform Tool for Employers At Blue Cross Blue Shield of Massachusetts, we know that your clients have questions about Health Care Reform. They want to know what regulations affect them and how they can comply with the law. To help address their questions and concerns, we’re in the process of creating a reference tool designed specifically for employers. This tool will be an easy-to-read table with an FAQ section that highlights the Health Care Reform regulations that pertain to your clients. A final version of this tool will be mailed with the June, 2007 edition of our Important Administrative Information; however, you can view the current version of our Health Care Reform Regulations Impacting Employers now. News from the Health Connector Affordability Regulations Approved, Waivers Ruling Postponed The board also voted to approve final regulations on affordability; however, they postponed the vote on who should get waivers in order to be exempt from individual mandate. The decision to delay a vote on waivers is based on the Health Connector’s desire to simplify the affordability schedule for the Department of Revenue who will enforce the law’s penalty while at the same time limiting the number of waivers issued. A final decision on waivers is expected at the July board meeting.   If the above links are not functioning in your email, copy and paste the URLs listed below into a browser window: MCC Regulations: http://www.bluecrossma-takecontrol.com/HCR_BLinks_files/MCC956CMR5.00Final060507.pdf Board Memo: http://www.bluecrossma-takecontrol.com/HCR_BLinks_files/MemoProposedRegulatoryChanges6-4-07.pdf Health Care Reform Regulations: http://www.bluecrossma-takecontrol.com/HCR_BLinks_files/HCRRegChart.pdf ® Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc. and Blue Cross and Blue Shield of Massachusetts HMOBlue, Inc. © 2007 Blue Cross and Blue Shield of Massachusetts, Inc. All rights reserved. Landmark Center, 401 Park Drive, Boston, MA 02215-3326 | 800-262-BLUE | TDD# 800-522-1254 An Independent Licensee of the Blue Cross and Blue Shield Association Terms of Use