The Obama administration recently released more than 700 pages of new regulations to implement various aspects of the Affordable Care Act (ACA). The rules cover the ACA’s health insurance exchanges and new standards and reforms to the insurance market, such as encouraging cost-sharing, stabilizing health insurance premiums and blocking insurers from denying coverage.
One set of rules requires insurers to report data on all rate increases, rather than just rate increases of 10 percent or more. The requirement will apply to health plans marketed to individuals, families and small businesses. Federal officials said the new rule is needed to provide additional data to monitor trends in premiums as the ACA takes effect.
Another rule requires insurers pool the claim costs of all their customers when setting rates in the individual market in a state. Similarly, insurers must consider the claim histories of all of their small-business customers when setting those rates. The requirement aims to ensure that premiums for certain products reflect the combined experience of all products in the market.
The medical-loss ratio regulation requires private insurers to spend a specific amount of premium dollars on direct medical costs or issue rebates to consumers if they do not comply with the ratio. Health and Human Services (HHS) changed the deadline for insurers to report how much they spend on medical care and quality improvement from June 1 to July 31. In addition, the annual deadline for insurers to issue any required rebates has been pushed back from August 1 to September 30.