• Analysis or Summary
  • April 25, 2019

Summary of Final Annual Guidance for Private Insurance Plans

This CHA summary of the 2020 Final Notice of Benefits and Payment Parameters highlights several policies that could impact children’s commercial health coverage. Each year, HHS releases this annual rule to set standards for qualified health plans in the Exchanges and, in some instances, the broader private insurance market, including: 

  • The continuation of increased state and insurer flexibility in benefit design and network adequacy
  • The maintenance of current essential community provider (ECP) standards, which include a lower minimum percent of ECPs, including children’s hospitals, that must be in Exchange plan networks
  • Changes in the methodology to calculate the annual cap on out-of-pocket expenses, which will increase the amount families with commercial coverage will need to pay before reaching the annual limit

HHS did not adopt its proposals that could have decreased access to brand-name drugs when a generic equivalent is available.