HRMorning.com » New rules: Insurers must justify steep rate hikes

New rules: Insurers must justify steep rate hikes

May 25, 2011 by Christian Schappel
Posted in: Employment law, Health care, In this week's e-newsletter - benefits, Latest News & Views, Money, Pay and benefits



The Department of Health and Human Services (HHS) says its latest rules will bring more transparency to the health insurance rate-setting process – and curb the huge price spikes we’ve seen recently.

Here’s what the new rules require:

  • Starting Sept. 1, 2011, states with “effective” review systems in place must examine any insurer’s proposed rate increase of 10% or more. To be considered effective, states must have the resources to determine whether a rate increase is unreasonable — and allow for public comments about the increase.
  • The HHS will help states strengthen their review process and conduct reviews for any state without an effective review system.
  • In 2012, the 10% threshold will be replaced by state-specific thresholds that are based on insurance cost trends in those areas.
  • The HHS will work with states to develop their thresholds.
  • Insurers under review must provide consumers with clear information about the reasons for rate increases deemed “unreasonable” and post their justifications for the increases on company and government websites.
  • Only states can reject rate increases. Currently two dozen states have laws that allow regulators to approve/disapprove certain insurance premium changes — and the laws vary widely.
  • The rules only affect non-grandfathered plans sold in the individual and small group markets. The HHS sees these groups as being the most vulnerable to large rate increases.

If these rules sound familiar, it’s because they are nearly identical to a proposal the HHS issued last December. The rules were just finalized. The biggest change from the initial proposal? The rules will take effect in September instead of July.

The feds say the rules will moderate insurance rate hikes. Do you agree — or do you think insurance costs should be attacked from a different angle? Share your opinion in the Reply box below.

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3 Responses to “New rules: Insurers must justify steep rate hikes”

  1. Matt Says:

    All insurance companies will do is raise rates 1% below the review level and game the system. Insurance companies are the most crooked businesses there are.

  2. Common Sense Says:

    “The rules only affect non-grandfathered plans sold in the individual and small group markets. The HHS sees these groups as being the most vulnerable to large rate increases” The reason these plans are most vulnerable to large rate increases is because the new law mandates that they cover benefits previously not covered. The administration says all new plans must have wellness care covered at 100% with not even a $10 copay and then they act surprised that insurance carriers have to raise their rates more than usual.

  3. Common Sense Says:

    “The Department of Health and Human Services (HHS) says its latest rules will bring more transparency to the health insurance rate-setting process”

    I would have liked to seen more “transparency” in the Democratic controlled congress which enabled all the backroom deals, bribes, arm twisting to pass this 2000+ page unread piece of legislation against the majority will of the American people.

    By the way Matt, insurance companies can not hold a candle to the crookedness of the government.

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