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The Center for Consumer Information & Insurance Oversight

 

Rate Review Data

Background

As of September 1, 2011, the Affordable Care Act and rate review regulation require review of rate increases of 10 percent or more. A non-grandfathered health plan sold in the individual or small group market that increases its rates by 10 percent or more is subject to review to determine whether the increase is unreasonable. Most states and territories have an effective rate review program and will review rate increases submitted by health insurance issuers in their states and territories. CMS will review rate increases in the market(s) where states do not have an effective rate review program. Additionally, effective January 1, 2014, all plans compliant with the rate monitoring and single risk pool requirements of the Affordable Care Act are required to submit all plans within the single risk pool.

For individual and small employer plans not subject to the single risk pool, each rate increase subject to review, a health insurance issuer must submit a Preliminary Justification for each product affected by the increase. This Preliminary Justification consists of the following parts:

Part I, Rate Increase Summary: A form that summarizes the data used to determine the rate increase. 
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 and the assumptions used to develop the rate increase, including an explanation of the most significant factors causing the rate increase. 

Part III, Rate Filing Documentation: Rate filing documentation that CMS uses to determine whether the rate increase is unreasonable. This section of the Preliminary Justification is only required to be filed when CMS is conducting the rate review.  It is posted on the CCIIO website.

For individual and small employer plans compliant with the single risk pool, 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 ratereview@cms.hhs.gov with questions regarding the rate review information that is posted on this website or to submit comments on proposed increases.

Data

Preliminary Justification for Non-Single Risk Pool Plans