PPACA Regs Target High Health Insurance Rate Hikes

PPACA Regs Target High Health Insurance Rate Hikes

New proposed PPACA regulations released this month by HHS will bring new transparency and scrutiny to proposed health insurance rate increases. These proposed rules allow HHS to work with states to require insurers to publicly disclose and justify unreasonable rate increases.

The proposed regulations will require insurers in all states to publicly justify any unreasonable rate increases beginning in 2011. In 2011, proposed rate increases of 10 percent or higher will be publicly disclosed and thoroughly reviewed to determine if the rate increase is unreasonable. After 2011, state-specific thresholds would be set using data and trends that better reflect cost trends particular to each state. Insurance companyís justifications for unreasonable increases will be posted on HealthCare.gov and the insurance planís website.

Under the proposed regulation, states with effective rate review systems would conduct the reviews. If a state lacks the resources or authority to do thorough actuarial reviews, HHS would conduct them. Meanwhile, HHS will continue to make resources available to states to strengthen their rate review processes.

In 2014, PPACA empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance exchanges.

For more information on the regulation, go to: http://www.healthcare.gov/news/factsheets/ratereview.html. For links to the regulation or other premium review information, go to: www.hhs.gov/ociio/initiative/index.html.

Recently John Steele and Steve Young, both managing directors, HealthScape Advisors, shared how health plans can develop a sound policy for premium rate increases that will meet with regulatory approval during a December webinar, Health Plan Rate Setting: Balancing Premium Increase Against Regulatory Oversight.

In case you missed this webinar, you still have a chance to hear this highly-rated program.

Register to listen today or order your training DVD or CD:

Steele and Young discussed:

  • How community rating and risk adjustment is changing the rate review process and creating new variables into the process;
  • Strategies and other solutions that health plans can implement now to prepare for immediate and long-term rate review changes;
  • How minimum medical loss ratios (MLR) will be used in the rate review process;
  • How unreasonable rate increases will be defined; and
  • The impact of transparency on rate reviews.

You'll also get to listen to the question and answer session to hear how the MLR regulations issued in November by HHS impact the rate setting process and the rate review process; the importance of a proactive regulatory affairs department in getting rates approved in the future; and where rate setting process fits into the larger picture of health reform.

You can "attend" this program right in your office and enjoy significant savings ó no travel time or hassle; no hotel expenses. Itís so convenient! Invite your staff members to listen to this conference. We will send you a DVD or CD-ROM of the conference proceedings or a link to our web site with a username and password. You can log in and listen to the program right from your computer ó any time of the day or night, whenever convenient for you and your colleagues ó and benefit from the archived recording of the conference, including the Q&A period.

To register for the on-demand re-broadcast of Health Plan Rate Setting: Balancing Premium Increase Against Regulatory Oversight or order the training DVD or CD-ROM, please visit:

I hope you find it useful.


Melanie Matthews
Executive Vice President
The Healthcare Intelligence Network