HHS may extend rate reviews to large group market

After issuing the proposed rule for reviewing insurance rate increases, the Department of Health and Human Services still has some big decisions to make.

Federal regulators will consider applying the rate review program to the large group market, reports The Hill’s Healthwatch. The rule currently only applies to insurance plans in the individual and small group market, but an HHS official said the department still might choose to apply the regulation to the large group market. If review requirements are extended to large groups, it would provide new oversight to a market that isn't accustomed to such scrutiny.

HHS specifically asked for feedback on its decision to exclude the large group market from state scrutiny. According to the proposed regulation, only 18 states have some form of rate review for this market.

In addition, HHS will need to flesh out more details on how states should set up acceptable processes to review unreasonable health insurance premium hikes, a National Association of Insurance Commissioners (NAIC) official told Healthwatch.

The proposed rule describes four criteria for an effective review process, but NAIC past president Sandy Praeger said the organization will work with HHS to develop clearer guidance.

"We'll know at some point in the future," Praeger said. "There may be some additional guidance from HHS about what they want states to be doing, and I think that's an ongoing process."

To learn more:
- read the Healthwatch article about the large group market
- here's the Healthwatch story on state review

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