HHS Finalizes Insurance Coverage Reforms for Individuals, Small Groups
Feb. 25—The U.S. Department of Health and Human Services issued a final rule prohibiting health insurance plans from denying coverage due to preexisting medical conditions or from charging individuals and small employers higher premiums based on health status, gender, or occupation.
Under the rule—which implements insurance market reforms outlined under the Affordable Care Act—premiums for individuals and small groups (small employers) can only vary based on family size, geography, age, and tobacco use. Individual and small-group plans must accept everyone who applies for coverage. Additionally, the final rule guarantees renewability of coverage.
Insurers must maintain a single risk pool for the individual market and one for the small-group market. Under the final rule, enrollment standards for catastrophic plans for young adults and people who cannot otherwise afford health insurance also are outlined.
The rule also requires health plans to submit data on all proposed rate increases in a standardized format and revises the states’ timeline to propose thresholds for rate review. Most of the rule’s provisions take effect 60 days after publication in the Feb. 27 Federal Register and apply to health plan or policy years beginning in 2014.
Publication Date: Monday, February 25, 2013