This bulletin clarifies the Office of the Commissioner of Insurance's (OCI) policy regarding Section 1302(c)(2) of the Patient Protection and Affordable Care Act (ACA) for insurers offering small group health insurance plans outside of the Federally Facilitated Exchange (FFE) that will be established in Wisconsin.
Section 1302(c)(2) of the ACA states:
In the case of a health plan offered in the small group market, the deductible under the plan shall not exceed (i) $2,000 in the case of a plan covering a single individual; and (ii) $4,000 in the case of any other plan. The amounts under clauses (i) and (ii) may be increased by the maximum amount of reimbursement which is reasonably available to a participant under a flexible spending arrangement [FSA] described in section 106(c)(2) of the Internal Revenue Code of 1986 (determined without regard to any salary reduction arrangement).
Pursuant to clear statutory authority in Section 1302(c)(2) of the ACA and consistent with federal regulations, Wisconsin insurers offering small group health insurance plans outside of the FFE will be allowed to increase the deductibles of a small group health plan (i.e., reimbursement available to an employee under a FSA may increase the deductibles of a small group health plan). This will help ensure that a larger percentage of small employers and their employees will be able to maintain their current health care coverage.
This bulletin applies to all insurers offering comprehensive small group health insurance plans outside of the FFE beginning January 1, 2014. Any questions concerning this bulletin should be directed to Mollie Zito at (608) 261-6017 or