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U.s. Department Of Labor Issued ' Faqs About Affordable Care Act Implementation ( Part 31 )

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April 2016 FAQ
The U.S. Department of Labor issued “FAQs about Affordable Care Act Implementation (Part 31)” on April 20, 2016. Question 8 stated:
Q8. “When performing “substantially all” and “predominant” tests for financial requirements and quantitative treatment limitations under MHPAEA, may a plan or issuer base the analysis on an issuer’s entire overall book of business for the year”?
The answer was quite a surprise to most actuaries that perform MHPAEA compliance testing:
“No. Basing the analysis on an issuer’s entire overall book of business expected to be paid for the year or book of business in a specific region or State is not a reasonable method to determine the dollar amount of all plan payments under MHPAEA. To the extent group health plan-specific data is available, each self-insured group health plan must use such data in making their projections. For large fully-insured group health plans, for which the premiums are determined on an experience-rated basis, the issuer should generally have group health plan-specific data to make projections. If a large, fully-insured plan does not have sufficient group health plan-specific data to make projections, data from other similarly-structured group health plans with similar demographics can be utilized for the analysis.
For insured small group and individual market plans, the health insurance issuer should use data at the “plan” level (as opposed to the “product” level) to perform the substantially all and

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