ACA Update: Final Rule for Health Insurance Marketplace Reforms

ACA Update: Final Rule for Health Insurance Marketplace Reforms

Friday, February 22, 2013

HHS issued a final rule implementing five Affordable Care Act (ACA) health insurance market reforms, covering:

  • Guaranteed availability (most plans offering coverage cannot deny offering of coverage to individuals and employers because of existing or pre-existing conditions).
  • Fair health insurance premiums (health insurers can allowed to vary premiums only on the basis of age, tobacco use, family size, and geography).
  • Guaranteed renewability (companies cannot refuse to renew coverage because the policy holder became sick).
  • Single risk pool (health insurers cannot charge higher premiums to higher risk individuals by moving them into separate risk pools); insurers must now maintain a single statewide risk pool for the individual market and one risk pool for the small group market.
  • Catastrophic plans (health insurers can offer these lower cost but limited coverage plans to young people and those who would otherwise find coverage to be unaffordable).

Read the fact sheet on the market reform final rule or read the rule in its entirety.

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