The proposed rule also prohibits benefit designs that discriminate against potential or current enrollees, includes standards and options for benefits not typically covered, such as habilitative services, and includes standards for prescription drug coverage.
The plans will be graded according to actuarial value and named after metals. For example, in a silver plan, which has a 70% actuarial value (the percentage of total average costs for covered benefits that a plan will cover), the enrollee would be responsible for 30% of costs, while in a platinum plan, which has a 90% actuarial value, the consumer would be responsible for 10%.
2. Market reform
The administration said this proposed rule will correct insurance practices today that deny many of 129 million people—or 1 in 2 non-elderly Americans with some form of pre-existing health condition—individual health insurance or exclude their coverage from certain benefits.
Starting in January 2014, the rule would implement five key provisions of the PPACA, Cohen said.
Insurers in the individual and small group markets "will have to sell policies to all consumers regardless of their health status or health history," would not be able to charge more to someone "just because she is sick, or because she used to be sick, or because she's a woman, or because of where she works," will not be able to cancel or refuse to renew coverage because of an enrollee's illness, can't charge enrollees different premiums, and will ensure that young adults and those who can't afford regular coverage would have access to a catastrophic plan in the individual market, Cohen said.
An important element in the proposed rule is the establishment of an age rating, or age bands, system, for people who are older than 20 and younger than 64. Each year (rather than every five years as had been suggested), the allowable health premium rate would be allowed to increase. The difference between the age band rate at 63 would be no more than three times the rate for people who are 21.