HHS Releases Final Rule on Health Insurance Market, Rate Review

News Alert: February 25, 2013

HHS Releases Final Rule on Health Insurance Market, Rate Review

The U.S. Department of Health and Human Services released a final rule on Feb. 22, 2013 that implements key provisions of the Affordable Care Act (ACA), including the requirement to cover people with pre-existing conditions.

The final rule further implements five provisions of ACA that are applicable to non-grandfathered health plans:

  • Guaranteed Availability
    Individual and small group policies will be guaranteed available subject to open and special enrollment periods in the individual market.
  • Health Insurance Premiums
    Health insurance companies offering coverage to individuals and small employers can vary premiums based on age, tobacco use, family size and geography. The rule implements the age rating at no greater than 3:1 and tobacco use rating at 1.5:1.
  • Guaranteed Renewability
    Health insurance companies must renew coverage subject to certain exceptions such as non-payment of premium.
  • Single Risk Pool
    Insurers are required to maintain a single statewide risk pool for claims experience in the individual market and single statewide risk pool for the small group market.
  • Catastrophic Plans
    Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market.