First Ever Rate Review Process Could Lead to Lower Health Insurance Rates

First Ever Rate Review Process Could Lead to Lower Health Insurance Rates

Consumers Council of Missouri, July 2015

Missouri is the only state in the country in which the Department of Insurance has no authority over health insurance rates.  As a result, under the requirements of the Affordable Care Act the federal Department of Health and Human Services reviews the rates for Missouri.

Because the state doesn’t review rates on behalf of consumers, Consumers Council of Missouri teamed up with Missouri Foundation for Health to analyze the rates for 2016 and let HHS know which rates we believe are unreasonable and excessive.  This is the first time health insurance rates will be reviewed in Missouri before they go into effect.

Unlike some state insurance departments, HHS doesn’t have the authority to disapprove rate increases in the states, but it does have the authority to deem them unreasonable.  And if HHS finds an insurer’s rate increase to be unreasonable, both it and the insurance company must post that finding on their websites.

That’s not a lot of help for consumers.  But it’s something.  And in the past, in other states, some insurance companies have reduced their rates after HHS found them to be unreasonable.

Within the next few weeks CCM will be posting on its website its analysis of the rates for the next enrollment period and the comments we send to HHS about unreasonable, excessive rates.  We will encourage consumers and advocates to file their own comments based on our analysis and will give step-by-step instructions on how to construct and file comments.  Comments may be either emailed to [email protected] or submitted at https://ratereview.healthcare.gov/ .

How the Rate Review Process Works

When insurance companies increase their rates they include a Rate Filing Justification, or RFJ, which contains the documentation supporting the increase.  The RFJ consists of three parts.

Part I is a compilation of the data used to determine the increase.  Part II is a summary explanation of the assumptions used to develop the increase and the most significant factors responsible for the increase.  Part III is the actuarial memorandum and exhibits, which contain the assumptions and reasoning supporting the increase and the data contained in Part I.

Under its Rate Review Rule, HHS must make the filings public in time for consumers to comment on proposed increases and for HHS to consider those comments in determining whether the rate is unreasonable.

Anyone wishing to file comments with HHS on rate increases in Missouri can do so at[email protected].  As noted above, more detailed instructions will come after CCM makes its analysis of the rates and comments public.

CCM has produced a guide to rate filing and rate review, Health Insurance Rate Review for Missouri Consumers, which anyone wishing to comment should find helpful.  Click here to see the guide.

Unfortunately, HHS declined to make the data for either 2014 or 2015 public in time for consumers to comment on proposed rate increases.  However, after CCM filed a Freedom of Information Act complaint in federal district court in St. Louis seeking the timely release of the data, HHS agreed to make public the proposed increases for 2016.  It will also make them available in future years by June 1 of the year before the rate hikes take effect.

HHS has therefore now posted data for 2016 rates at a new website,www.ratereview.healthcare.gov.  Some information in the Part III’s has been redacted – blackened out -- because insurers claim that information is trade secret.

HHS has also released to CCM, in connection with CCM’s FOIA complaint, the Part III’s supporting 2015 (this year’s) rates.  Because many of those Part III’s are unredacted, they include data that the 2016 Part III’s do not include. That may make them particularly useful to consumers wishing to comment on proposed 2016 rates.  Click on each rate filing to view it.

2015 Aetna Small Group HMO

2015 Aetna Small Group PPO

2015 Anthem Individual

2015 Anthem Small Group 1-1-2015

2015 Anthem Small Group 4-1-2015

2015 Blue Cross and Blue Shield of Kansas City Individual-1

2015 Blue Cross and Blue Shield of Kansas City Individual-2

2015 Celtic Exhibits A&B

2015 Celtic Individual Major Medical

2015 Cigna Individual

2015 Coventry Individual HMO

2015 Coventry Individual PPO

2015 Coventry Individual

2015 Coventry Small Group HMO

2015 Coventry Small Group PPO-1

2015 Coventry Small Group PPO-2

2015 Cox Individual

2015 Cox Small Group

2015 Federated Small Group

2015 Freedom Individual Major Medical

2015 Humana Individual

2015 Humana Small Group

2015 John Alden Small Group Major Medical

2015 Time Individual Major Medical

2015 Time Small Group Major Medical

2015 United Health Care Individual-1

2015 United Health Care Individual-2

2015 United Health Care Small Business-1

2015 United Health Care Small Business-2

To search the Part I's, Part II's and redacted Part III's requested in 2015 for 2016 and in 2014 for 2015, go to https://ratereview.healthcare.gov > Search ACA-Compliant Products > Choose a State > Missouri > Submit Search

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