The Center for Consumer Information & Insurance Oversight (CCIIO) has posted a guide states can use to fine-tune the population data health insurers use to come up with rates for residents.
CCIIO — the arm of the Centers for Medicare & Medicaid Services (CMS) in charge of managing the parts of the Patient Protection and Affordable Care Act (PPACA) that affect the commercial health insurance market — published this guide for states that want to replace the data in the standard federal Actuarial Value Calculator with state-specific data.
Health insurers are supposed to use a state’s AV calculator to design and price PPACA-compliant qualified health plans that fit into the bronze, silver, gold and platinum metal level system. A bronze plan is supposed to cover about 60 percent of the actuarial value of the PPACA essential health benefits (EHB) package, and a top-level, platinum plan is supposed to cover about 90 percent of the actuarial value of the EHB package.
CCIIO has also published a collection of federal Actuarial Value Calculator Continuance Tables, or tables that describe “the distribution of claims spending for a population of health insurance users who face a particular benefit structure,” officials say.
To qualify to replace the federal calculator data with state data, a state must blend 48 continuance tables of its own for every combination of metal level, gender and age bracket into 12 continuance tables weighted to a fit a defined standard population, officials say.