Clarification Of Final Rules For Grandfathered Plans, Preexisting Condition Exclusions, Lifetime & Annual Limits, Rescissions, Dependent Coverage, Appeals, & Patient Protections Under The Affordable Care Act

The document was released on May 3, 2018, jointly by the U.S. Departments of Labor, Health and Human Services, and the Treasury. The document presents the departments' reasoning behind a previous rule that set a methodology called "Greatest of Three" by which health plans can set a price to reimburse out-of-network emergency care professionals. The methodology calls for health plans to pay the out-of-network emergency professional the greatest of three possible reference prices: the Medicare rate; the median network rate for the emergency service furnished; or an amount calculated using the same method the plan . . .