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  • Rule Finalizes Consumer Protections Under ACA

    The Department of Health and Human Services (HHS) issued a final rule last week implementing several consumer protections under the Affordable Care Act (ACA) to prevent insurance companies from discriminating against people with preexisting conditions and protect consumers from insurance company abuses.

    Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

    These 5 key provisions are applicable to nongrandfathered health plans:

    • Guaranteed Availability—Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
    • Fair Health Insurance Premiums—Health insurance companies offering coverage to individuals and small employers will be allowed to vary premiums based only on age, tobacco use, family size, and geography.  Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
    • Guaranteed Renewability—Health insurance companies will no longer be permitted to refuse to renew coverage because an individual or an employee has become sick. Consumers may renew coverage at their option.
    • Single Risk Pool—Health insurance companies will no longer be able to charge higher premiums to higher-cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single statewide risk pool for 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. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

    In preparation for the health insurance marketplaces and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program. HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests. A new report has found that the law's transparency provisions have already resulted in a decline in double-digit premium increases filed, from 75% in 2010 to, according to preliminary data, 14% in 2013.


    • Excellent news and thanks for the update!

      Posted by Chris on 3/4/2013 11:36 AM

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