Final Rule Sets Reform-Mandated Restrictions on Insurers
The Department of Health and Human Services has issued the latest in a number of final rules establishing new processes for health insurers under the Affordable Care Act.
The Department of Health and Human Services has issued the latest in a number of final rules establishing new processes for health insurers under the Affordable Care Act.
The new rule prohibits denying coverage based on preexisting conditions, charging individuals and small employers higher premiums based on gender or health status, and segmenting enrollees into separate rating pools to charge high-risk individuals more for their premiums.
Under the rule, insurers can vary premium rates in the individual and small group markets, within certain limits, only on the basis of family size, geography, age and tobacco use. Insurers must accept every employer or individual who applies for coverage in the group and individual markets, subject to certain exceptions.
“This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare and Medicaid Services,” according to the rule. It is available here with publication scheduled on February 27.
The new rule prohibits denying coverage based on preexisting conditions, charging individuals and small employers higher premiums based on gender or health status, and segmenting enrollees into separate rating pools to charge high-risk individuals more for their premiums.
Under the rule, insurers can vary premium rates in the individual and small group markets, within certain limits, only on the basis of family size, geography, age and tobacco use. Insurers must accept every employer or individual who applies for coverage in the group and individual markets, subject to certain exceptions.
“This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare and Medicaid Services,” according to the rule. It is available here with publication scheduled on February 27.