Actuarial Value of Coverage

Purpose:

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


Intent:

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