Actuarial Value Calculation

Do large groups have to comply with the Actuarial Value calculation of the metallic option plans? For example, do large groups have to comply with the 60, 70, 80 percent, etc. requirements?

No, but applicable large employers must offer “minimum value” plans, which can be met by offering plans with 60 percent of actuarial value. However, the calculations for minimum value are slightly different than actuarial value, and BCBSNE is awaiting a minimum value calculator from the federal government.

If applicable large employers (50+ full-time equivalents) do not offer minimum value, they may be subject to a penalty if at least one employee receives a subsidy through the Exchange (also called Marketplace).​

Will qualified health plans (QHP) be offered outside of the Exchange (also called Marketplace)?​

Plans sold outside the Exchange must meet Actuarial Value metallic levels. Technically, these plans will not be certified QHPs. But if a plan mirrors a QHP sold on the Exchange, it could be considered a QHP outside the Exchange as well.