HSA Consulting Services, LLC

High deductible plans should be exempted from the minimum MLR standards. Such an exemption was requested in comment letters submitted by the American Bankers Association HSA Council, America’s Health Insurance Plans, and the Council for Affordable Health Insurance. If you are unwilling to provide an exemption, a more appropriate MLR standard for high deductible plans would be one that reflects the actuarial value standard for the plan. For example, a “Bronze” plan with a 60 percent actuarial value would have a 60 percent minimum MLR requirement applied. A third option would be to allow all insurance companies to count claims paid below the deductible (by the members, not the plan) for covered benefits as “claims paid by insurance” solely for purposes of calculating whether the plan meets the MLR. This would eliminate the inherent bias against high deductible plans which are designed not to pay first dollar claims. A fourth option would be to change the formula for calculating the MLR so that the credibility adjustment factor and cost-sharing adjustment factors are applied independently. For example, the cost-sharing adjustment factor could be applied to the MLR (via multiplication) before the credibility adjustment factor is added.