Health Insurance Premium Review Rule Published

On May 19th, HHS published a final rule regarding the disclosure and review of “unreasonable premium increases” required by Section 2794 of the Public Health Service Act, added by ACA Section 1003. The rule stipulates:

• Beginning September 1, 2011, insurers seeking rate increases of ten percent or more for non-grandfathered plans in the individual and small group markets will be required to publicly disclose and justify the proposed increases.
• Beginning September 1, 2012, a state-specific threshold will be set for disclosure of rate increases. HHS will work with states to develop the thresholds using state-specific cost data and trends.
• States with effective rate review systems will analyze proposed increases to determine if they are reasonable. HHS will conduct the reviews for states that lack the resources or authority to do thorough actuarial reviews. HHS expects the majority of states to be able to conduct reviews.
• HHS will publish consumer-friendly forms that insurers must use to propose rate increases and to inform consumers about the proposed rate increases.
• Information on the outcome of all reviews, including the justification provided by insurers for rate increases determined to be unreasonable, will be posted on the HHS website. Health plans will also have to justify increases on their own websites.