Affordable Care Act & Actuarial Value
Friday, September 27th, 2013The term “actuarial value” has not been frequently used, even in the insurance business…yet! Even those in the business may have a hard time understanding it and even harder time explaining it. But the Affordable Care Act (ACA) uses actuarial value to describe many of the requirements and restrictions for compliant plans, so it becomes increasingly important to understand and explain what this term means and how it applies in a post-ACA world.
Actuarial value is often seen as the “true” value of a plan. It is the percentage of covered costs that the plan expects to pay for an enrollee in the plan. As an example, a person with a plan that had an actuarial value of 70% would be responsible for on average 30% of the cost of the covered benefits under the plan. Depending on the behavior of the enrollees in the plan, the actual value of the plan may vary slightly. Until the passage of ACA, “actuarial value” was not a household term. Long-time insurance employees likely have a loose grasp on the concept, but in the post-reform world, it will be a commonly used tool to estimate the true value of a plan.
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