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February 14, 2018

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Medical Coding News Archives

Disclosure Notices to Make Insurance Rate Increases Transparent

April 1, 2011:
A proposed disclosure form for health insurance rate increases over a certain threshold aims to prevent consumers from being blindsided by rate hikes.

The Centers for Medicare and Medicaid Services (CMS) published the proposed form on its website to comply with a provision in the Affordable Care Act that requires subscribers to be notified when insurers consider a rate increase of greater than 10 percent. The form would require specifics on the increase and could be accessed by consumers through the Department of Health and Human Services website so that they could view the details of the increase while it is still being reviewed by either the state or federal government. CMS would also require health insurance issuers to post a notice about the increase on their own websites.

The Director of the Center for Consumer Information and Insurance Oversight points out that subscribers are often left out of the loop when it comes to the reasons driving insurance rate increases. This new, detailed information will “provide an unprecedented level of transparency” within health care, leading to equal competition. This may help control the rising cost of health care as well as maintain a benchmark for reasonable rates.

The notices CMS has proposed would break down the increase so that the consumer could follow what is being proposed and why. Additionally, the subscriber could view what the insurance company believes is causing the increase and how much of those funds would go toward medical services versus profit and retained earnings and administrative expenses. The form would also include a brief history of rate increases for the plan.

In the first year the form is used, beginning as early as July 2011, disclosures would have to be posted for rate increases greater than 10 percent. After that, the states could establish their own amount limit for consumer notification by using information and trends specific to that state.

The proposed disclosure notices are part of the premium rate review regulation that HHS distributed in December and applies to “grandfathered insurance plans in the individual and small group markets.” CMS has posted the proposed disclosure plan on its website under “CMS-10379.”

Kristin Bentley
Clinical/Technical Editor


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