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Consumer disclosures proposed for health insurance rate increases Posted: March 8th, 2011

By Maryalene LaPonsie

As early as July, health insurance companies may have to comply with a new review process for certain premium increases. The Centers for Medicare & Medicaid Services (CMS) has published a proposed consumer disclosure form for all health insurance rate increases in excess of 10 percent.

The Patient Protection and Affordable Care Act (PPACA) requires medical insurance companies to justify premium increases that could be considered unreasonable. Under the proposed CMS rules, consumers would be provided with the following four pieces information:

  1. Average price of monthly premiums after the increase
  2. Average percentage increase in premiums for affected health plans
  3. Breakdown of factors causing the increase, including medical costs, profits and administrative fees
  4. Rate increase data from previous years

The disclosure form also breaks down the medical costs contributing to health plan premiums, including categories for hospital inpatient, outpatient facilities and prescription drugs.

Under proposed rules, the consumer disclosure and rate reviews will be required for medical insurance premium increases that exceed pre-defined thresholds. In 2011, that threshold is 10 percent and set by the federal government. However, in 2012, states will be able to set their own thresholds based upon regional trends.