Insurance Market Reform

This notice with comment describes the overall Quality Rating System (QRS) framework for rating Qualified Health Plans (QHPs) offered through an Exchange. The purpose of this notice is to solicit comments on the list of proposed QRS quality measures that QHP issuers would be required to collect and report, the hierarchical structure of the measure sets and the elements of the QRS rating methodology. In addition, this notice solicits comments on ways to ensure the integrity of QRS ratings, and on priority areas for future QRS measure enhancement and development.

This final rule maintains the protections of the Mental Health Parity Act of 1996 and adds new protections. The rule requires insurance companies to offer mental health and substance-use disorder benefits that are comparable to their medical and surgical benefits. However, the final rule does not require employers to offer mental health coverage.

This most federal guidance clarifies that individuals have until March 31, 2013 to enroll in coverage through the health insurance marketplaces to avoid being subject to the penalty for not maintaining minimal essential coverage.

The Multi-State Plan Program, established under the Affordable Care Act , directs OPM to contract with private health insurers in each State to offer high-quality, affordable health insurance options called Multi-State Plans (MSPs). MSPs are being administered in 30 states and the District of Columbia. This map details the MSP options that are available in the participating states.  

This analysis of rate review activities in calendar year 2012 shows that the rate review process saved consumers approximately $1.2 billion on their premiums when compared to the amount initially requested by insurers. In the individual market, the average rate request increase dropped by 12 percent after rate review, saving consumers an estimated $311 million. In addition to the $1.2 billion saved due to rate review, consumers received an additional $500 million in medical loss ratio rebates for 2012, for a total $1.7 billion in savings in 2012. Moreover, insurers were much less likely to submit requests for rate increases of 10 percent or more in 2012 than in previous years, and it is likely that this change in issuer behavior is a result of the Affordable Care Act policy that requires requests for increases of 10 percent or more to be justified and reviewed.