Health Insurance Market Rules and Rate Review – Proposed by Centers for Medicare & Medicaid Services (CMS):
- Guaranteed issue coverage for individuals with pre-existing conditions if coverage is purchased during open or special enrollment periods.
- Limiting premium variance based on age to 3 to 1 and tobacco use to 1.5 to 1.
- Requiring insurers to maintain a single risk pool for their small group and individual policies in each state.
- Allowing catastrophic plans for young adults and people for whom coverage would otherwise be unaffordable.
- The proposed rule also includes some changes to the current rate review program. Insurers will have to submit all individual and small group rate increases to HHS beginning in 2014.
Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation – Proposed by HHS:
- Outlines health insurance issuer standards related to the coverage of essential health benefits (EHB) and the determination of actuarial value (AV) and minimum value; provides state flexibility to shape how EHB are defined; provides for limits on cost sharing.
- Proposes a timeline for when issuers offering coverage in a Federally-facilitated Exchange or State Partnership Exchange must become accredited.
- Proposes an application process for accrediting entities seeking to be recognized to fulfill the accreditation requirements for issuers offering coverage in any Exchange.
Wellness Programs in Group Health Plans – Proposed by HHS, Labor and the Treasury:
- Effective for plan years beginning on or after January 1, 2014. Expand existing HIPAA wellness program rules to apply in the individual market. The maximum reward will increase from 20% to 30% of the cost of health coverage. For programs designed to prevent or reduce tobacco use, the maximum reward will be 50%.
