Actuarial Value of Coverage


To require health plans to measure and communicate the percentage of anticipated annual expenses the plan will reimburse


To allow participants and employers to compare health plans and make informed decisions to purchase one plan versus another

Related Provision:

Cost-Sharing Limits
Minimum Value of Coverage

Health Plans Affected by this Provision:

Year Effective: 2014
Medical Plan: Yes, all plans, individual or small employer plan, unless plan is Grandfathered, a plan in effect and without significantly changed coverage or premium share since March 23, 2010
Dental/Vision Plan: No, if stand-alone benefit excepted from HIPAA’s portability provisions
HRA: Not Applicable, but value of new HRA funding can be used in actuarial value calculation
Health Care FSA: Not applicable

Document Downloads:

Document Title Last Updated
Actuarial Value Flyer  
PHSA Actuarial Value  
HHS Calculator Methodology, February 2013 02/01/2013
HHS Bulletin, March 2012