Rate Increase Disclosure and Review Reporting Requirements (CMS-10379)

The Patient Protection and Affordable Care Act (Pub. L. 111–148) was enacted on March 23, 2010; the Health Care and Education Reconciliation Act (Pub. L. 111–152) was enacted on March 30, 2010. In this statement, we refer to the two statutes collectively as the Affordable Care Act. The Affordable Care Act reorganizes, amends, and adds to the provisions of Part A of title XXVII of the Public Health Service Act (PHS Act) relating to group health plans and health insurance issuers in the group and individual markets. Section 1003 of the Affordable Care Act adds a new section 2794 of the PHS Act which directs the Secretary of the Department of Health and Human Services (the Secretary), in conjunction with the States, to establish a process for the annual review of “unreasonable increases in premiums for health insurance coverage.” Additionally, section 2794 also directs the Secretary, in conjunction with the States, to monitor all rate increases effective 2014. The statute provides that this process shall require health insurance issuers to submit to the Secretary and the applicable State justifications for unreasonable premium increases prior to the implementation of the increases. Section 2794 also directs the Secretary to ensure the public disclosure of information and justification relating to unreasonable rate increases.

The latest form for Rate Increase Disclosure and Review Reporting Requirements (CMS-10379) expires 2022-10-31 and can be found here.

Health Insurance Issuer Submission of the Preliminary Justification

Federal Enterprise Architecture: Health - Health Care Services