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Guest Article
(From the May 31, 2011 issue of Deloitte's Washington Bulletin, a periodic update of legal and regulatory developments relating to Employee Benefits.)
The Department of Health and Human Services (DHHS) released its final regulations establishing a process for the review of potentially "unreasonable" premium increases for health insurance coverage offered in the individual and small group markets, as required under the Patient Protection and Affordable Care Act. The final rule is essentially unchanged from the earlier proposed version, although the effective date for the review process is moved from July 1, 2011 to September 1, 2011. Comments are specifically requested on whether and how the process should apply to insurance sold through associations and group trusts.
The review process requires that rate increases in the individual and small group market be reviewed for "unreasonableness" if they equal or exceed state-specific thresholds that will be set annually by the DHHS. The final rule reaffirms that, unless another limit is set by the DHHS, a 10 percent threshold will apply. Rate increases that meet or exceed the applicable threshold must be reviewed to determine whether the increase is unreasonable. If not subject to an approved state review program (i.e., a state "effective rate review program"), the increase will be reviewed by the Centers for Medicare & Medicaid Services (CMS). The review process will apply to changes in rates on or after September 1, 2011.
In addition to delaying the effective date of the review process, the final regulations:
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Comments on the final rule are requested by July 18, 2011.
The information in this Washington Bulletin is general in nature only and not intended to provide advice or guidance for specific situations.
If you have any questions or need additional information about articles appearing in this or previous versions of Washington Bulletin, please contact: Robert Davis 202.879.3094, Elizabeth Drigotas 202.879.4985, Mary Jones 202.378.5067, Stephen LaGarde 202.879-5608, Erinn Madden 202.220.2692, Bart Massey 202.220.2104, Tom Pevarnik 202.879.5314, Sandra Rolitsky 202.220.2025, Deborah Walker 202.879.4955. Copyright 2011, Deloitte. |
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