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HHS issues final rule on 2014 insurance reforms

Sunday February 24, 2013
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The Department of Health and Human Services has issued a final rule that implements consumer protections from the Affordable Care Act in an effort to make the health insurance market work better for individuals, families and small businesses.

The final rule implements five key provisions of the Affordable Care Act that are applicable to non-grandfathered 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. Factors that no longer will be permitted include health status, past insurance claims, gender, occupation, how long an individual has held a policy and size of the small employer.

Guaranteed renewability: Health insurance companies no longer will refuse to renew coverage because an individual or an employee has become sick. Individuals may renew their coverage at their option.

Single risk pool: Health insurance companies no longer will be able to charge higher premiums to higher-cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single state-wide risk pool for the individual market and a single state-wide 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.

More information about the reforms is available at http://cciio.cms.gov/resources/factsheets/marketreforms-2-22-2013.html.


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