Reform provisions - rate review


The rate review final rule, effective Sept. 1, 2011, requires insurers of individuals/small groups and individuals/small group association plans to provide detailed information to the states and/or HHS for any proposed increase equal to or greater than 10 percent (the threshold), along with the reason for the proposed increase. States deemed to have effective rate review programs will be able to set state-specific thresholds beginning Sept 1, 2012.

40 states and the District of Columbia have “effective” rate review programs, meaning that these states will conduct the required reviews, not HHS. Two states (Pennsylvania and Virginia) have “effective” rate review programs in the individual market only. Six states (Alabama, Arizona, Louisiana, Missouri, Montana and Wyoming) do not have an “effective” program and will therefore have rate increases that meet or exceed the federal threshold reviewed by HHS.

The U.S. Department of Health and Human Services (HHS) also launched the website for public disclosure of rate requests on Oct. 6, 2011.

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