2024 Pay or Play Affordability Percentage

Remaining 2022 Notice of Benefit & Payment Parameters Finalized

The Department of Health and Human Services (HHS) recently finalized the second Notice of Benefit and Payment Parameters (NBPP) for 2022. The final notice — which follows the first final 2022 NBPP published on January, 19, 2021 — sets forth payment parameters and provisions related to the risk adjustment program and cost-sharing parameters.

The regulations apply to the 2022 benefit year and include the following:

  • For individual coverage, the annual out-of-pocket maximum limitation will increase to $8,700 ($400 lower than the initial proposal). For family coverage, the maximum limitation will increase to $17,400 ($800 lower than the initial proposal).
  • The required contribution percentage for catastrophic coverage eligibility will decrease from 27% to 8.09% for 2022.
  • An additional special enrollment period (SEP) for Exchange coverage to allow enrollees who lose premium tax credit eligibility to change to a new plan through the Exchange. Individuals who were unaware that an SEP triggering event took place will be allowed to select a new qualified health plan within 60 days.

For reference, the first notice of benefit and payment parameters included updated user fees for issuers offering plans through the Exchange, as well as the establishment of enrollment options, payment standards related to individual coverage HRAs (ICHRAs) or qualified small employer HRAs and amended Section 1332 waiver procedures.

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Should you have any questions regarding this information, please do not hesitate to contact Creative Benefits, Inc. at 866-306-0200 or solutions@creativebenefitsinc.com