Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)

OMB 0938-1258

OMB 0938-1258

The final rule "Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review" implements sections 2701, 2702, and 2703 of the Public Health Service Act (PHS Act), as added and amended by the Affordable Care Act, and sections 1302(e) and 1312(c) of the Affordable Care Act. The rule directs that states submit to CMS certain information about state rating and risk pooling requirements for their individual and small group markets, as applicable. Specifically, states will inform CMS of age rating ratios that are narrower than 3:1 for adults; tobacco use rating ratios that are narrower than 1.5:1; a state-established uniform age curve; geographic rating areas; whether premiums in the small group market are required to be based on average enrollee amounts; and, in states with pure community rating, uniform family tier structures and corresponding multipliers. In addition, states that elect to merge their individual and small group market risk pools into a combined pool will notify CMS of such election. This information will allow CMS to determine whether state-specific rules apply or Federal default rules apply. It will also support the accuracy of the federal risk adjustment methodology.

The latest form for Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454) expires 2021-03-31 and can be found here.

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