Health Care and Life Sciences > Health Reform Resource Center > HHS Publishes Rate Review Regulation
22 Dec '10

On December 21, 2010,  the Department of Health and Humans Services (HHS) published a proposed rule that provides guidance for when a premium increase will trigger review as required by the Patient Protection and Affordable Care Act (PPACA).  For 2011, the regulation establishes a 10% premium increase threshold, above which insurers in the small group and individual market must submit a “preliminary justification” supporting the reason for the change.  For 2012 and future years, this threshold will be either the 10% level or a state-specific threshold (depending on the costs of health care in the state).  States or HHS will consider the justifications and determine if the increase is unreasonable, defined as excessive, unjustified or unfairly discriminatory.  A finding that the increase is unreasonable does not mandate that the insurer withdraw the premium change; instead, HHS will publicize the determination on its website for consumers and others to view.