Final Regulations To Stabilize Individual Health Insurance Market Issued

Final Regulations To Stabilize Individual Health Market Issued

The Department of Health and Human Services (HHS) issued final regulations to help stabilize the individual and small group markets on April 13, 2017, These final regulations take effect June 19, 2017, and do not significantly differ from the proposed regulations issued February 16, 2017. They will not directly impact large group health plans.

They are intended to help stabilize the Health Insurance marketplace, and provide more flexibility for states and insurers, as well as to give individual health plan consumers more coverage options.

These rules will include the following policy changes:

  • Shortened 2018 Annual Open Enrollment Period: The final rule adjusts the annual open enrollment period for 2018 to more closely align with Medicare and the private market. The next open enrollment period will start on November 1, 2017, and run through December 15, 2017, encouraging individuals to enroll in coverage prior to the beginning of the year.
  • Fraud and Abuse Protections: The final rule promotes program integrity by requiring individuals to submit supporting documentation for special enrollment periods and ensures that only those who are eligible are able to enroll. It will encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties and help to lower premiums.
  • Encourage Continuous Coverage: The final rule promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.
  • Offer Additional Consumer Choices: For the 2018 plan year and beyond, the final rule allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.
  • Reduce Duplication and Empower States:  The final rule reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the federal government.  The rule returns oversight of network adequacy to states that are best positioned to evaluate network adequacy.


Additional guidelines regarding the compliance processes for insurers were also released.  These include updates to align these guidelines with the final regulations, and include information needed by insurers to have their plans certified for 2018.

These guidelines include:   Key Dates for 2017Issuer Guidance on Uniform Rate Review TimelineGood Faith Compliance GuidanceQHP Certification Guidance for States; and Final Actuarial Value (AV) Calculator for 2018 and Methodology.

A full text of the final rule in PDF format can be downloaded here.

Additional information, as well as the original CMS release can be found here. For additional information on how these guidelines may affect your or your small business, contact a Roper Insurance Health Insurance expert at [email protected].