Update: Group Healthcare Plans Not Providing Coverage for Hospital Care Won't Pass Obamacare's “Minimum Value” Test

From Jerry Geisel at Business Insurance:

Group health care plans that do not provide coverage for hospital care will not pass the health care reform law’s “minimum value” test, but the Internal Revenue Service is giving a one-year pass to existing or soon to be implemented plans excluding the coverage. 

Ending months of uncertainty on the issue, the IRS on Tuesday said such plans do not provide the minimum value requirement and that regulators will shortly propose regulations to this effect. 

The IRS announcement involves a section of the Patient Protection and Affordable Care Act that imposes, starting in 2015, stiff penalties on employers offering plans that do not pass an ACA minimum value test. 

To pass that test, plans must pay for 60% of covered services. If a plan does not pass the minimum value test, lower-income employees — those earning up to 400% of the federal poverty level — can go to public insurance exchanges to obtain coverage, with the federal government subsidizing their premiums. In that situation, employers are liable for a $3,000 penalty for each employee who obtains the subsidized coverage. 

Likely due to a flaw in a government online calculator, low-cost plans that excluded coverage for hospital services were able to pass the minimum test, benefit experts said. 

That, in turn, fueled interest in the plans, which cost about half the price of more traditional plans, especially from employers who have not offered coverage and starting in 2015, faced an ACA mandate to offer coverage or be hit with a stiff financial penalty. 

But in its Tuesday announcement, the IRS said plans excluding hospital coverage fail the minimum value requirement. 

The IRS, in its notice, suggested that its calculator gave faulty results. The IRS, Treasury and the Department of Health and Human Services are considering whether the calculator produced “valid actuarial results.” ...

IRS Notice 2014-69 goes on to provide that an employer who "has entered into a binding written commitment to adopt, or has begun enrolling employees in, a Non-Hospital/Non-Physician Services Plan prior to November 4, 2014 based on the employer’s reliance on the results of use of the MV Calculator" shall be not be harmed by this anticipated regulatory change provided the "plan year begins no later than March 1, 2015." (Top of page 2 in IRS Notice 2014-69.)

* Note: Jerry Geisel's original version of this article stated that the agreement to provide non-hospital benefits could have been a "nonbinding" commitment." However, alert reader Mary Jonelle Thompson pointed out that she could not find that provision in the IRS release.  Upon further review, I've updated this post as I believe the original Business Insurance column had a typo in it.  

 And from Jay Hancock writing at St. Louis Today:

Moving to close what many see as a major loophole in Affordable Care Act rules, the Obama administration will ban large-employer medical plans from qualifying under the law if they don’t offer hospitalization coverage.  

The administration intends to disallow plans that “fail to provide substantial coverage for in-patient hospitalization services or for physician services,” the Treasury Department said in a notice Tuesday morning. It will issue final regulations banning such insurance next year, it said. 

Hundreds of lower-wage employers such as retailers and temporary-staffing companies have been preparing to offer such plans for 2015, the first year large companies are liable for fines if they don’t provide minimum coverage. Some have enrolled workers for insurance beginning Oct. 1.

For employers that have committed as of Nov.4 to such coverage, the administration will temporarily allow it under the health law, the notice said. ...

Allison Bell over at LifeHealthPro points out an interesting nuance for folks who've already installed a skinny plan:

You or your clients might run up against a "duty to inform" requirement. 

The agencies want an employer that offers a non-hospital plan -- including a non-hospital plan set up before Nov. 4, 2014 -- to correct any earlier disclosures that stated or implied that the plan might keep the enrolled employee from qualifying for a PPACA premium subsidy tax credit. 

If an employer with a non-hospital plan fails to tell an employee that the employee is still eligible for a tax credit, the agencies will consider the plan as implying that the employee was ineligible for the tax credit, officials say. 

Officials did not say what penalties employers might face if the agencies find that employers use poorly explained non-hospital plans to discourage employees who might qualify for the premium subsidy tax credit from applying for the tax credit. 

Here is the official notice from the IRS: Group Health Plans that Fail to Cover In-Patient Hospitalization Services.

We predicted this change and discussed it last week on the Armstrong and Getty Show.  Audio here:

  

Debate Heats Up Over "Skinny" Obamacare Plans with No Hospitalization Benefit

This is from Jay Hancock at Kaiser Health News:

Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits. 

“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.” 

Timothy Jost is pretty sure the whole thing was a mistake. 

“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said. 

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. 

At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the “minimum value” test for adequate benefits. 

The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a calculator-certified plan shields employers from penalties of up to $3,120 per worker next year. 

Many insurance professionals were surprised to learn from a recent Kaiser Health News story that the calculator approves plans lacking hospital benefits and that numerous large, low-wage employers are considering them. 

Although insurance sold to individuals and small businesses through the health law’s marketplaces is required to include expensive hospital benefits, plans from large, self-insured employers are not. 

Many policy experts, however, believed it would be impossible for coverage without hospitalization to pass the minimum-value standard, which requires insurance to pay for at least 60 percent of the expected costs of a typical plan. 

And because calculator-approved coverage at work bars people from buying subsidized policies in the marketplaces that do offer hospital benefits, consumer advocates see such plans as doubly flawed. 

Kaiser Health News asked the Obama administration multiple times to respond to criticism that the calculator is inaccurate, but no one would comment. 

Calculator-tested plans lacking hospital benefits can cost half the price of similar coverage that includes them. 

While they don’t include inpatient care, the plans offer rich coverage of doctor visits, drugs and even emergency-room treatment with low out-of-pocket costs. 

Who will offer such insurance? Large, well-paying employers that have traditionally covered hospitalization are likely to keep doing so, said industry representatives.... 

But companies that haven’t offered substantial medical coverage in the past — and that will be penalized next year for the first time if they don’t meet health-law standards — are very interested, benefits advisors say. 

They include retailers, hoteliers, restaurants and other businesses with high worker turnover and lower pay. Temporary staffing agencies are especially keen on calculator-tested plans with no hospital coverage. 

Benefits administrators offering the insurance say it makes sense not only for employers trying to comply with the law at low cost but for workers who typically have had little if any job-based health insurance....  

Such plans come with deductibles as low as zero for doctor visits and prescriptions and co-pays of only a few dollars, they say. Emergency-room visits cost members in the $250 or $400 range, depending on the plan. 

By contrast, health-law-approved insurance with inpatient benefits often includes deductibles — what members pay for all kinds of care before the insurance kicks in — of $6,000 or more.... 

Concerned for their reputations, larger administrators are wary of managing benefits without hospitalization, even if they do pass the calculator. 

“Our self-funded customers hand out insurance cards to their employees with Blue Cross all over it,” said Michael Bertaut, health care economist at BlueCross BlueShield of Louisiana, which has no plans to handle such coverage. “Do we really want someone to present that card at a hospital and get turned away?” 

There are two health-law coverage standards that large employers must meet to avoid paying a penalty. 

One, for “minimum essential coverage,” merely requires some kind of employer medical plan, no matter how thin, with a potential penalty next year of up to $2,080 per worker. Many low-wage employers are meeting that target with “skinny” plans that cover preventive care and not much else, say brokers and consultants. 

The calculator tests the health law’s second, more exacting standard — to offer a “minimum value” plan at affordable cost to workers. Failure to do so triggers the second penalty, of up to $3,120 per worker. 

The argument over the calculator is whether plans carving out such a large chunk of benefits — hospitalization — can mathematically cover 60 percent of expected costs of a standard plan. 

They probably can’t, Jost said. The fact that the calculator gives similar, passing scores to plans with hospital benefits and plans costing half as much without hospital benefits suggests that it’s flawed, he said. Plans with similar scores should have similar costs, he said. 

On the other hand, others ask, why did the administration make a calculator that allows designers to leave out inpatient coverage? Why didn’t the law and regulations require hospital coverage for self-insured employers — as they do for commercial plans sold through online marketplaces? 

“The law and calculator were purposely designed as they are!” Fred Hunt, past president of the Society of Professional Benefit Administrators, said in an email widely circulated among insurance pros. “No ‘glitch’ or unintended loophole.” 

“That’s baloney,” said Robert Laszewski, a consultant to large insurers and a critic of the health law. “Nobody said we’re going to have health plans out there that don’t cover hospitalization. That was never the intention… I think they just screwed up.”

  

The 'Skinny Plan' Option is Not Without Risk

This is a very easy to read and pithy summary of the desire to use and issues around 'skinny plans' from Josie Martinez writing at SHRM: 

As the implications of health care reform become more apparent, large employers in the U.S. are increasingly grappling with coverage options to avoid the penalties. 

A continuing issue concerns the problems that health care reform poses for the staffing industry and similar employers, as these companies may find themselves obligated to offer health coverage to relatively short-term and variable-hour employees.

Affordability Penalty Refresher

Under the Affordable Care Act (ACA), employer-provided coverage is considered "unaffordable" if it (1) costs more than 9.5 percent of the employee's W-2 wages, or (2) doesn’t cover an average of 60 percent of the employee's medical expenses. Once the ACA employer mandate takes effect, if an employer with the equivalent of 50 or more full-time workers does not provide affordable coverage to full-time workers (based on a 30-hour work week), those workers can shop for insurance through a public exchange and may qualify for a federal premium subsidy or tax credit. An employer would face a penalty of $3,000 per each full-time worker who receives a subsidy/credit. 

As described below, the affordability penalty is separate from the "pay or play" (or "shared responsibility") employer mandate to provide health coverage or pay a penalty of $2,000 per each full-time employee.

One option some employers are looking at is the offer of a "skinny" or non-minimum-value plan. This is a group health plan that provides medical care but may not satisfy the 60 percent minimum actuarial value threshold under the ACA, which mandates that plan participants pay no more than 40 percent of covered medical expenses. 

Granted, if an employer offers a plan that is not minimum value, an employee may apply for a federal subsidy or tax credit for coverage purchased through a public health care exchange, and this could trigger a penalty of $3,000 per each full-time employee that receives a subsidy/credit. But this penalty would be lower than the penalty associated with not offering any health plan at all (the "play or pay" employer mandate's $2,000 penalty times every full-time employee). 

Non-minimum-value plans are starting to make their way into the market for just this reason—as a viable alternative to staffing firms and other low-wage, high-turnover companies. At the end of the day, it allows employers to satisfy the ACA's "play or pay" coverage requirement and avoid the hefty penalty associated with that option. So, it minimizes [I would quibble slightly here and say lessens as opposed to minimizes as there are still potential fines and issues alive in this strategy.] the risk financially. Also, if employees accept the “skinny” plan, they will not themselves be penalized with the individual mandate's tax penalty currently in effect for not having coverage—in some respects, a win-win for both parties. 

Skinny and Not-So-Skinny Choices 

Some employers are using a modified version of this strategy. These employers offer employees two options: (1) a skinny plan, and (2) a richer option with a minimum actuarial value over 60 percent and a premium contribution cost that just barely meets the ACA's 9.5 percent wage threshold, which few low-income employees are expected to take because of the cost. This strategy enables employees to opt for the skinny plan that they can afford, while the offer of the richer option immunizes the employer from the "play or pay" penalties. 

A third strategy is to simply offer the richer option and allow it to be unaffordable. For example, the plan could be offered on a fully contributory (i.e., employee pays all) or nearly fully contributory basis. This strategy avoids the “no offer” penalty, although the employer is still liable for the “unaffordable” penalty, but only with respect to those employees granted a premium subsidy or tax credit. 

[And here is the part I want to make sure we emphasize:] 

Keep in mind, these strategies are aggressive. There are those who argue that skinny plans will not provide sufficient coverage to satisfy the “minimum essential coverage” criteria, which under current regulations seems a possibility. Eventually, these plans may not pass muster, but for now there is nothing definitive against going this route. ...

 The bold lettering is mine.

Obamacare's Race to the Bottom: ‘Skinny plans’ Gain Traction As Necessary PPACA Evil

'Skinny plans' are a new flavor of group health plans – generally designed to replace what used to be called 'Mini-med' plans – that provide very basic medical care, but do not satisfy the 60% "minimum value threshold" under the health care reform law.  Despite that, they appear to be legal, at least for now - stay tuned as change-on-the-fly is more common that adherence to law at this point.  

  
  Distinction:  

• Minimum value threshold means that the plan covers 60% of anticipated medical costs.  In the Exchanges these are called "bronze plans."   
• Minimum essential coverage refers to a list of 10 required benefits (generally preventive and wellness-style benefits) mandated in individual and small group plans.  Large employers of more than 50 employees in California may offer a subset of these 10 mandated benefits.  

Providing employees with “minimum essential coverage,” (as opposed to minimum value coverage) as mandated by PPACA, means the health plan will include the 10 essential benefits outlined under the law.  However, PPACA regulations only require carriers to offer those 10 benefits in plans sold in the individual or small-group markets.  Companies with 50 or more full-time employers are not required to provide workers with this more-generous list of protections. Although still referred to as “minimum essential coverage,” large employers only need offer workers a subset of preventive services akin to a glorified wellness plan. These newly spawned 'Skinny plans' are only costing between $50 and $100 per employee per month. 

With a 'Skinny plan' a large (over 50 in California) employer can offer a very minimalistic wellness-only style of benefit and avoid the $2,000 per employee PPACA penalty.  It would not, however, avoid the $3,000 per employee penalty for those employees who go into Exchanges and receive a subsidy. The thought is, many folks won't bother going into the Exchanges and the employer will avoid most penalties.  

This is a perfectly classic illustration of government intervention making things markedly worse.  All that the industry is doing here is replacing one kind of existing "Mini-med' plans with even less robust 'Skinny plans' - many mini-med had a limited hospital benefit while most Skinny plans do not.  So now we, as a society, are burning thousands of hours of time, money and resources to create these new, lesser-than-a-mini-med plans to skirt the largest sledgehammer within Obamacare. 

This is from Bruce Jacobs at Benefits Pro (Hat Tip - Ryan Kennedy):

While a typical “skinny plan” may offer preventive services such a wellness element, a few doctor visits per year, and generic drugs, for example, it doesn’t provide arguably the most important element of any medical coverage: payments for surgery and hospitalization. Under a “skinny plan,” if your Pinto gets rear-ended and you land in the hospital and need an operation or two, financially, you are on your own. 

Regardless, these plans are permitted under PPACA regulations. ... 

See also on 'Skinny Plans':  

• Obamacare Penalties Spawn 'Skinny' Plans to Skirt Most Employer Penalties
• The New Mini-Med: Why Health Law's 'Essential' Coverage Might Mean 'Bare Bones'
• Getting Around PPACA's $2,000 Penalties in 2015 with a 'Skinny Plan'

Getting Around PPACA's $2,000 Penalties in 2015 with a 'Skinny Plan'

This is attorney, George Reardon writing at StaffingIndustry.com: 

The Affordable Care Act’s employer mandate may have been delayed by a year, but come 2015, staffing firms will have had to decide whether to offer insurance or pay the penalties. For the moment, at least, there’s a middle-ground option that many staffing firms are considering.

A loophole in the Affordable Care Act allows employers to avoid the heaviest “employer mandate” penalty of $2,000 per all full-time employees per year by offering so-called “skinny plans” -- a group health plan designed to cover only non-catastrophic health exposures like wellness benefits, preventive care and certain routine medical care. Staffing firms planning to offer skinny plans hope the savings from avoiding the “no offer” penalty will outweigh the combined cost of the skinny insurance and penalties generated by employees who reject the skinny insurance and obtain subsidized coverage from state exchanges.

But the plans are not without risk. For example, some employees who accept the employer’s insurance may not fully understand the limited scope of its coverage and believe that it is comprehensive health insurance. 

Before ACA, employers would not have portrayed the benefits of skinny plans as health insurance; they would have called them wellness benefits. Most employees aren’t very knowledgeable about health insurance. Few of them will understand what a skinny plan is or, more important, what it is not....

A catastrophic health expense would be a cruel way for these employees to learn about the limits of their coverage. ...

Sponsors of skinny plans should plan to explain to their employees continually and in plain language that such plans are not the equivalent of traditional health insurance and that they need to consider obtaining comprehensive catastrophic coverage through state exchanges or elsewhere. ... 

The New Mini-Med: Why Health Law's 'Essential' Coverage Might Mean 'Bare Bones'

It came as a surprise to some that the Affordable Care Act seems to allow large employers to offer health insurance that pays for preventive care and not much else. Check out our story on "skinny" plans quoting a consultant saying that for employers with 50 or more workers, “the feds imposed no minimum standard on how skimpy that coverage can be other than to say, in essence, it’s got to be more robust than a dental plan or a vision plan." (The Wall Street Journal broke the story here in May. Subscription required.)

Retailers, restaurant chains and temporary staffing companies are said to be interested.

But how can a law praised for expanding coverage -- one that includes an "employer mandate" to offer "minimum essential coverage" -- allow companies to offer insurance that might not even cover hospitalization?

Take a walk through the ACA weeds to see why.

First of all, there is no outright ban on skinny plans -- even after the employer mandate kicks in in 2015. Instead, large employers -- those with 50 or more full-time employees -- run the risk of fines only if the coverage doesn't conform to ACA rules. The regulations published so far, however, seem to allow skinny plans with a penalty that many employers may choose to pay because it is less costly than offering fuller coverage.

There are two fines in the health law for large employers failing to offer adequate coverage. First, any company that does not offer "minimum essential coverage" is liable for a $2,000-per-worker penalty (minus the first 30 workers), triggered when at least one employee enrolls in subsidized coverage in the online marketplaces known as exchanges.

But what is minimum essential coverage? Not as robust as you might think. To start, don't confuse it with "essential health benefits," including maternity benefits and prescription drugs, that must be included in plans sold to individuals or small employers.

If health insurance is merely sponsored by an employer, it passes one test for minimum essential coverage.

Now how good does that employer insurance have to be? The regulations are obscure, defining minimum essential coverage largely in terms of what it is not. For example, "limited-scope dental or vision benefits" are not minimum essential coverage. Nor is "coverage only for a specified disease or illness."

Neither the law, nor the regulations say much about what minimum essential coverage offered by a large employer is. As a result, many experts believe large employers can shield themselves from the $2,000 penalty by offering a plan that covers the health law's required preventive care, but still leaves workers vulnerable to thousands in bills if they're hospitalized. If employees sign up for such plans, which may cost as little as $50 a month, they would also be protected from health-law penalties levied on individuals without coverage.

The health law also fines employers that don't offer "minimum value" in their health plans, says Alden Bianchi, a Boston-based benefits and compensation lawyer. Skinny coverage flunks that test, based on regulations that measure minimum value against "benchmark plans" in each state, Bianchi said. But the employer penalty is only $3,000 for each worker enrolling in subsidized exchange coverage. That's likely to be much less than the fine for not offering minimum essential coverage, which is $2,000 for nearly every employee in the company, even if most don't buy policies in the exchanges.

But what about other rules governing health benefits? What about the part of the health law that bans insurers from cutting off benefits at a certain dollar level? Not a problem for skinny plans. Unlike the "mini-med" plans in common use before the law was passed, they don't impose a dollar cap; they merely exclude large categories of care, which also keeps down costs.

What about new rules limiting out-of-pocket expenses for consumers? For 2014, your plan can't make you pay more in co-pays and deductibles than $6,350 for individuals and $12,700 for families. (That may temporarily be higher if your employer has separate administrators for drug benefits and doctors and hospitals.) Skinny plans pass the test again. Out-of-pocket caps are for covered care only, and skinny plans don't cover much care.

What about restrictions on self-insured employers (the large majority of large companies are self-insured) offering a rich-benefit plan to managers and a limited-benefit plan to hourly workers? Skinny plans survive this one, too, says Ed Fensholt, a senior vice president at Lockton Cos., a large insurance broker. These non-discrimination rules contain exceptions for high-turnover workers, he said. And they require employers only to offer the management plan to hourly workers, not for the workers to enroll.

"That plan would be priced at a place where relatively few rank and file employees would want it," Fensholt says. "And then they'd offer the skinny plan to the rank and file."

When asked about the situation, the Obama administration said consumers lacking good coverage "can enter into the marketplaces and choose a health insurance option that works for them."

Bianchi, who represents large employers, says the people who wrote the law intended to give companies a bare-bones option.

"The ability to offer such plans is a result of conscious policy decisions by Congress, as implemented by the regulators," he wrote in an industry brief.

The Cato Institute's Michael Cannon, on the other hand, suspects the administration "had no idea what they were doing," as he wrote on the libertarian think tank's blog.

Source: Why Health Law's 'Essential' Coverage Might Mean 'Bare Bones' - Kaiser Health News. 

Obamacare Penalties Spawn 'Skinny' Plans to Skirt Most Employer Penalties

• A Treasury Department official confirmed that properly designed skinny (mini-med) plans meet the requirements of the health care law. 
• The premium for these plans would be around $50 a month. 
• About 1.4 million Americans had mini-med plans in 2010.

This from Politico: 

Employers heaved a sigh of relief when the Obama administration announced it would not enforce Obamacare’s mandate that large companies provide insurance to their workers next year.

But some companies plan to offer “skinny plans” designed to duck the biggest penalties anyway, according to industry consultants. And the Obama administration has extended its blessing to this limited coverage, even though it would not protect individuals from medical bills that could cause financial ruin in the case of severe injury or illness.
The health law spells out in detail the comprehensive coverage that insurers have to provide on the new insurance marketplaces or exchanges. But it’s nearly silent about what the employers who provide insurance to a majority of Americans need to include in their health plans.
“There are no rules on how good that coverage has to be,” said Gretchen Young, senior vice president of health policy at the ERISA Industry Committee....
“There are particular employers in particular industries for whom the Affordable Care Act is a disaster,” said Andy Anderson, who leads the health division at the law firm Morgan, Lewis & Bockius in Chicago. The Congressional Budget Office estimates the penalties would bring in $3.7 billion per year.
The health care law required employers with the equivalent of 50 or more full-time workers to provide health insurance or else pay a $2,000 per employee fine, starting in 2014. After intense lobbying from the business community, the Treasury Department announced earlier this month that the mandate won’t take effect until 2015.
The penalty is a fraction of the roughly $8,000 it costs to provide an employee with comprehensive health insurance. But it would be a major new expense for large employers that don’t pay for coverage now.
A firm with 2,500 employees would pay about $5 million in penalties each year.
But there’s a second penalty that gets less attention. Large employers that don’t provide robust, affordable insurance to their workers will pay a $3,000 penalty for each employee who gets taxpayer-funded subsidies on an exchange.
And there is a new type of insurance plan that is designed to protect employers from the first penalty and lower their exposure to the second. They are the skinny plans, a descendant of limited benefit — or “mini-med” — plans that are set to be phased out at the end of this year.
“Skinny alternatives are an attempt to manage liability for ACA penalties,” said Neil Trautwein, employee benefits policy counsel at the National Retail Federation.
The idea is that far fewer employees will go to the exchanges if they have an affordable alternative in the workplace.
Unlike the plans sold through the exchanges, company-backed insurance does not have to cover the 10 categories of services in the health care law’s essential health benefits.
There are a few standards, however.
Skinny plans will have to cover preventive services like vaccines and cancer screenings without any cost-sharing — a requirement of all insurance under the health law. They can’t put a cap on annual benefits, as limited benefit, or mini-med, plans typically do now. But the lack of a cap is largely symbolic because the plans don’t cover the services that run up medical bills.
They could offer very limited coverage of hospitalizations or surgeries, for instance, and a certain number of doctor office visits and a narrowly tailored prescription drug benefit. The premium for these plans would be around $50 a month, said Richard Stover, a principal in New Jersey-based Buck Consultants, who has clients that plan to offer skinny plans next year....
And those who want more comprehensive coverage can still go to the exchanges, where they may be eligible for subsidies depending on their income.
“That may be a better option for employees who need better coverage,” Stover said. For those employees who do receive subsidies on the exchange, their employers would have to pay a $3,000 penalty, but it’s likely to be a smaller subset of the workforce, Stover said.
The most likely group of employees to be offered skinny plans next year are those who work for employers that have mini-med plans now. About 1.4 million Americans had mini-med plans in 2010....
A Treasury Department official confirmed that properly designed skinny plans meet the requirements of the health care law....