September 2016


EPW Developing Industry Response to Draft Notice of Benefit & Payment Parameters

The NADP Exchange Policy Workgroup (EPW) will meet this week to discuss the recently proposed Notice of Benefit and Payment Parameters for insurance Marketplaces in 2018 and develop comments from the industry.

The following list includes broad topics covered in the proposed rule. We will post a more detailed summary in the Dental Interact (DI) Advocacy Open Forum after EPW review.

  • Changes to age rating bands
  • Plan design and cost-sharing parameters
  • User fees for federally-facilitated and state-based Marketplaces (which as proposed, would remain 3.5% in federal marketplace states and increase to 3.0% for state-based marketplaces that lease technology)
  • Standardized plans or “Simple Choice Plans”
  • Consumer assistance tools and taglines
  • Network adequacy and essential community providers
  • Small Business Health Option Program (SHOP)
  • Market reforms
  • Dental MOOP (calculation stays the same, and as 2016 is the base year for considering increases to dental Consumer Price Index (CPI), the Maximum Out-of-Pocket (MOOP) remains $350/$700)

Interested members should reach out to Eme Augustini with thoughts or questions on the proposed rule and any items the EPW should consider in developing comments.



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