Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: January 30, 2019

Program Area: CSR Reconciliation (CSR)

Question: At what level should the Simplified Actuarial Value (AV) method formula apply for plans with embedded out-of-pocket limitations?

Answer: The annual limitation used in the simplified AV methodology calculation is always the annual limitation of the policy level, (for example, other than self-only for the standard plan). As discussed on p. 23 of the CSR reconciliation manual for 2014 and 2015 benefit years, "Issuers must use the other than self-only annual limitation on cost sharing for the standard plan for family plans with embedded individual limits."

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.