The Center for Consumer Information & Insurance Oversight
Rate Review Data
Section 2794(a)(1) of the Public Health Service (PHS) Act requires the Secretary, in conjunction with States, to establish a process for the annual review of unreasonable premium increases for health insurance coverage. Section 2794(a)(2) of the PHS Act requires health insurance issuers to submit to the Secretary and relevant State a justification for an unreasonable premium increase prior to implementation. Most states have an effective rate review program and will review rate increases submitted by health insurance issuers in their states. CMS will review rate increases in the market(s) where states do not have an effective rate review program. For single risk pool filings a rate increase is subject to reasonableness review if the average increase meets or exceeds the threshold specified in 45 C.F.R. 154.200.
A health insurance issuer must submit a Rate Filing Justification for each plan in the single risk pool. This Rate Filing Justification consists of the following parts:
Part I, Uniform Rate Review Template: A form that summarizes the data used to determine rate increases for the entire single risk pool. CCIIO is also making the data in this form available on the CCIIO website for public use.
Part II, Written Explanation of the Rate Increase: A simple and brief narrative describing the data provided in Part I for any product(s) within the single risk pool which have rate increases subject to review, and the assumptions used to develop the rate increase, including an explanation of the most significant factors causing the rate increase.
Part III, Actuarial Memorandum:Rate filing documentation that states and CMS use to understand the actuarial assumptions, justifications and methodologies used to comply with the market rating rules and to complete the Part I template.
This page contains links to the rate review data posted on the CCIIO website. Please email firstname.lastname@example.org with questions regarding the rate review information that is posted on this website or to submit comments on proposed increases.
Preliminary Justification for Non-Single Risk Pool Plans
- Search tool for Parts I and II Preliminary Justification Information
This page contains a search tool to find non-single risk pool compliant Parts I and II Preliminary Justification information by state and issuer. Select “Search Transitional Products” to search for non-single risk pool products.
- Search tool for Part III Preliminary Justification Information
This page contains a search tool to find non-single risk pool compliant Part III Preliminary Justification Documentation by state and issuer for submissions in the five states where CMS performs the rate review.
- Public Use File for Non-Single Risk Pool Plans
The Public Use File (PUF) contains information found in Part I of the Preliminary Justification as well as other data fields displayed on RateReview.HealthCare.gov such as the review status. The zip file provides the Part I data in .csv and .xls formats as well a PUF documentation file that explains the variables included in the dataset. These files will be updated periodically.
Rate Filing Justification for Single Risk Pool Plans
- Search tool for Parts I, II, and III Rate Filing Justification Information
This page contains a search tool to find single risk pool compliant Parts I and II Rate Filing Justification information by state and issuer. For plans effective on or after January 1, 2016, the search tool also contains Part III Rate Filing Justification information. Select “Search ACA-Compliant Products” to search for single risk pool products.
- Public Use File for Single Risk Pool Plans
The PUF includes the single risk pool filing information found in Part I of the Rate Filing Justification as well as other data fields such as the review status. The zip file provides the Part I data in .csv format and also includes a data dictionary. These files will be updated periodically.
- Worksheet I and II Data for 2014 Single Risk Pool Filings (ZIP) (Updated November 4, 2016)
- Worksheet I and II Data for 2015 Single Risk Pool Filings (ZIP) (Updated November 4, 2016)
- Worksheet I and II Data for 2016 Single Risk Pool Filings (ZIP) (Updated November 4, 2016)
- Worksheet I and II Data for 2017 Single Risk Pool Filings (ZIP) (Updated October 25, 2017)
- Worksheet I and II Data for 2018 Single Risk Pool Filings (ZIP) (Updated January 3, 2018)
- Worksheet I and II Data for 2019 Single Risk Pool Filings (ZIP) (Updated October 26, 2018)
- Worksheet I, II and III Data for 2020 Single Risk Pool Filings (ZIP) (Updated December 11, 2019)
- November 5, 2019 FAQ: Quality Rating Information Bulletin’s (Quality Bulletin’s) Display Guidelines for Direct Enrollment (DE) Entities
- November 1, 2019 Enhanced Direct Enrollment Approved Partners (Updated)
- September 11, 2019 FAQ: Enhanced Direct Enrollment Participation Requirements for Non-Issuer of a Primary EDE Entity Environment
- August 15, 2019 Quality Rating Information Bulletin for Plan Year 2020 Health Insurance Exchanges Quality Rating System (QRS) for Plan Year (PY) 2019: Results at a Glance
- April 18, 2019 CMS-9926-F: Final HHS Notice of Benefit and Payment Parameters for 2020 Final 2020 Letter to Issuers on Federally-facilitated Exchanges Key Dates for Calendar Year 2019: QHP Certification in the FFEs; Rate Review; Risk Adjustment
- April 4, 2019 Guidance on Unified Rate Review Timeline: Timing of Submission of Rate Filing Justifications for the 2019 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2020
- March 19, 2019 2020 Final Actuarial Value Calculator 2020 Final Actuarial Value Calculator Methodology
- March 6, 2019 CMS-9921-NC: Request for Information Regarding the Sale of Individual Health Insurance Coverage Across State Lines Through Health Care Choice Compacts
- February 28, 2019 Section 1332 Pass-through Funding Tools and Resources