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
Rate Filing Justification for Single Risk Pool Plans