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Final 2015 HIX Rule Includes Measures to Stabilize Premium Rates

Christopher Cheney, for HealthLeaders Media, May 22, 2014

CMS officials say they are making changes to the HIX risk corridors program to account for "unexpected administrative costs and pricing uncertainties."

Federal officials have released market standards and regulations for the PPACA exchanges. The final 2015 rule, released last week, includes risk program adjustments crafted to ease upward pressure on premium rates, more robust collection of quality information from insurers, and tighter standards for "navigators" who help people pick the HIX health plan that best suits their needs.

In addition to those changes, the final rule requires health plans to make coverage decisions within 24 hours on essential prescription drugs that are not covered by the plan. It also provides flexibility to states in the administration of the Small Business Health Options Program, within which PPACA exchanges offer group insurance coverage to small employers.


Insurers Prep 2015 HIX Premium Rates


"This rule will help to improve consumer protections, keep premiums affordable, and make additional information available to consumers in the future, such as quality ratings that will help them to better compare and choose plans," CMS officials said in a blog post Friday.

Accounting for HIX Risk
In a fact sheet accompanying the rule's release, CMS officials said they are making changes to the HIX risk corridors program to account for "unexpected administrative costs and pricing uncertainties." The risk corridor changes feature raising the ceiling on administrative costs by two percentage points and raising the floor on profits by two percent.

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