Final Notice of Benefit and Payment Parameters for 2019

The following is an article overview. Click here to view the full compliance brief.


On April 9, 2018, the Department of Health and Human Services (HHS) released its final Notice of Benefit and Payment Parameters for 2019. This final rule describes benefit and payment parameters under the Affordable Care Act (ACA) that apply for the 2019 benefit year. Standards included in the final rule relate to:

• Annual limitations on cost sharing;
• The individual mandate’s affordability exemption;
• Special enrollment periods in the Exchange; and
• Essential health benefit (EHB) benchmark plan options.

Although the tax reform bill effectively eliminated the individual mandate penalty beginning in 2019, the final rule notes that individuals may still need the affordability exemption to determine eligibility for catastrophic coverage.

The final rule also makes changes to certain standards for enrollment in the Small Business Health Options Program (SHOP) Exchange. Finally, the rule eliminates standardized plan options in the federally facilitated Exchanges (FFEs).


  • • The ACA’s out-of-pocket maximum limit will increase to $7,900 (self-only coverage) and $15,800 (family coverage).
  • • The required contribution percentage for the individual mandate’s affordability exemption will increase for 2019.
  • • Standardized plans in the federal Exchange will be eliminated.

Important Dates

April 9, 2018

The 2019 Final Notice of Benefit and Payment Parameters was issued.

2019 Benefit Year

The changes included in the final rule generally apply for the 2019 benefit year (unless otherwise noted).

Please reach out to us if you have any questions.

This compliance update is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.