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All metallic policies under the Affordable Care Act - bronze, silver, gold, and platinum - are required to meet a specific "actuarial value." Because of that requirement, carriers are forced to make changes in their policies each year to account for a variety of cost factors, including inflation, in order to remain "ACA Compliant."

One of our California groups was unhappy to learn that their UnitedHealthcare Platinum $0 Deductible HMO Signature Plan - which had a $250 hospital admittance fee in 2016 - is going to a 30% coinsurance structure in 2017! With this change came a decrease in premium, even though the group client would prefer to have a price increase and the richer benefit.

In order to satisfy "actuarial value" in this case, UHC decided it would be better overall to use the coinsurance requirement on hospitalization than to increase copays on office visits and pharmacy benefits. This is the reason many of you see rising out-of-pocket maximums as well.

If you have a question about increasing premiums, please send us a message or give us a call!
Posted 10:38 PM  View Comments

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