HHS is still accepting comments until May 14 regarding the medical loss ratio provision of the Patient Protection and Affordable Care Act, in advance of future rule making. The comments, identified by DHHS-2010-MLR, can be submitted through http://www.regulations.gov or through the mail (one original and two copies) to Department of Health and Human Services, Attention: DHHS-2010-MLR, Hubert H. Humphrey Building, Room 445-G 200 Independence Ave SW, Washington D.C. 20201.

Reviewing Premiums


Before a year has passed from the enactment of the PPACA, HHS will develop standards in consultation with NAIC for insurers to compile and provide to enrollees a summary of the benefits and coverage explanation. The summary provided by insurers will require a uniform format: no longer than four pages and font no smaller than 12-point. The language must have terminology understandable by the average plan enrollee. The content of the summary will include uniform definitions of standard insurance terms and medical terms so that consumers may compare insurance coverage and understand the terms of coverage; a description of the coverage including cost-sharing, limitations on coverage, deductibles, coinsurance and co-payment obligations; renewability and continuation of coverage provisions; examples of common benefit scenarios such as pregnancy, serious or chronic medical conditions; and contact information for further questions.

HHS is also mandated to establish a process for the annual review of unreasonable increases in premiums for health insurance coverage. This process will require health insurers to submit to the OCIIO and the relevant state justification for an unreasonable premium increase prior to the implementation of the increase. The insurers will be required to post the information about the proposed rate increase on their websites.

As a condition of receiving grants, a state will be required to provide HHS with information about trends in premium increases in health insurance coverage for premium rating areas in the state, and to make recommendations as to whether particular health insurers should be excluded from the exchanges.

Prohibitions on Policies

Under the PPACA, group and individual coverage plans cannot establish lifetime limits on the dollar value of benefits for any beneficiary, or establish unreasonable annual limits on the dollar value of benefits unless permitted under federal or state law. New plans and existing group health plans cannot deny coverage for children due to pre-existing medical conditions.

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