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National Restaurant Association - NRA helps spur health insurance market rule clarification

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NRA helps spur health insurance market rule clarification

The work of National Restaurant Association helped ensure that employers won’t be blocked from buying insurance starting in 2014 if they can’t get a minimum percentage of employees to buy into the plans.

A rule clarification published Wednesday by the U.S. Department of Health and Human Services states that insurers must sell large- and small-group health plans to any employer that wishes to buy them, regardless of the employee participation level. Initially, the HHS rule stated that insurers offering plans in the “individual and group market” were required to sell to individuals or employers who wished to purchase plans, but did not state explicitly that the requirement applied to plans in both in the small- (fewer than 50 employees) and large- (more than 50 employees) group markets. As a result, many restaurant operators reported that insurers were still requiring participation rates in their contracts for 2014.  Large employers were particularly concerned that they’d be forced to pay penalties under the Affordable Care Act starting in 2015 for not offering coverage, even if insurers turned them down for coverage because they could not meet the participation rates.

NRA leaders met with the deputy HHS secretary in April to discuss concerns about insurers’ participation-rate requirements. In May, HHS contacted the NRA and said that the rule would be clarified to include small- and large-group plans. The regulation applies to plan years beginning on or after Jan. 1, 2014, for plans sold in the individual, small group, and large group markets.

The NRA’s work on this issue is part of its ongoing advocacy for reasonable changes to the health care law and flexibility in regulations to implement the law. Learn more about the NRA’s health care advocacy goals and how you can get involved at www.restaurant.org/healthcare.

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