Reform Alert - News from the Blues' Office of National Health Reform

HHS issues Bulletin providing standards for issuer's renewal notices

June 11, 2013

The Department of Health and Human Services (HHS) issued a Bulletin on May 6 providing standards for individual market renewal notices distributed by issuers of non-grandfathered health insurance coverage.

The Bulletin states that HHS prohibits issuers from using any marketing practices discouraging persons with substantial health needs from enrolling in health insurance coverage, including qualified health plans (QHPs) through the Health Insurance Marketplace. An issuer that provides renewal notices to existing enrollees deterring current enrollees from purchasing products could be in violation of this provision.

This guidance provides model language that issuers can use to provide notice to their existing customers about the new coverage options in the individual market, including QHPs, premium tax credits, and cost sharing reductions through Health Insurance Marketplaces, with coverage beginning January 1, 2014. Issuers are not required to use model language, but it does provide a safe harbor that meets the non-discrimination standards. The model language states:

You and your family may soon have new options for health care coverage. Starting on October 1, 2013, the Health Insurance Marketplace will offer a new alternative for purchasing health insurance plans. You can preview your premium, deductibles, and co-payment costs before you make a decision to enroll in a plan, and determine whether you qualify for assistance to reduce these costs. You can continue to purchase coverage from us in the Marketplace. You may find your premiums are lower due to a new kind of tax credit in the Marketplace. You might also qualify for plans with reduced deductibles and co-payments. Even though help with premiums, deductibles, and co-payments isn’t available outside the Marketplace, the health care law also guarantees that you can choose a new plan outside the Marketplace even if you have a preexisting condition.

Providing the above notice does not preclude an issuer from communicating additional information concerning its QHPs, web link to its direct enrollment website, or its other products.

Where can I find more information?
More information can be found at


The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.