What is minimum value coverage?
Minimum value coverage refers to a plan that provides Minimum Essential Coverage and provides minimum value. A plan that falls short of minimum value coverage often will still be considered Minimum Essential Coverage.
What is Minimum Value?
A plan is considered to provide minimum value when it pays on average at least 60% of the total allowed cost of benefits covered under the plan. This means that enrollees pay (via deductibles, coinsurance, copayments and other out-of-pocket amounts) on average no more than 40% of the total allowed cost of benefits. Minimum value does not take into account the amount paid for premium.
Confirming Minimum Value
Most employers are already offering plans that meet minimum value, and therefore the vast majority of medical plans offered in Zenefits meet the minimum value coverage threshold. Employers with insured plans can check with the insurer to determine if a plan meets the Minimum Value Coverage standard.
Insurers also must specify on the plan's Summary of Benefits and Coverage if coverage is minimum value coverage. For self-funded plans, administrators will need to calculate whether the Minimum Value Coverage threshold is met.
The Department of Health and Human Services (HHS) provides an online Minimum Value Calculator, along with instructions, that can be used to determine whether a plan meets the Minimum Value Coverage standard. Applicable large employers who do not provide coverage that meets these standards are subject to penalties.
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