Insurance Premium Rate Reviews

The Affordable Care Act (ACA) includes provisions to increase the scrutiny and transparency of health insurance rate increases. The law requires insurance companies to publicly justify any unreasonable rate increases.


Government Resources

  • Rate Increases Disclosure and Review: Definitions of "Individual Market" and "Small Group Market", CMS, HHS, 9/6/2011 Final rule amends the definitions to include coverage sold to individuals and small groups through associations

  • Rate Increase Disclosure and Review, CMS, HHS, 5/23/2011 Final rule to require review and disclosure of large health insurance premium increases and the reasons for those increases. Starting September 1, 2011, requires independent experts to scrutinize any proposed increase of 10% or more for most individual and small group health insurance plans. Starting September 2012, the 10% threshold will be replaced by state-specific thresholds that reflect the insurance and health care cost trends in each state.

  • Rate Increase Disclosure and Review , CMS, HHS, 12/23/2010 Proposed rule on procedure to allow HHS to work with states to require insurers to publicly disclose and justify unreasonable premium increases