U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Rate Justification Program


The Affordable Care Act authorizes HHS to focus special attention on rate increase requests that are potentially “unreasonable.”  By regulation, HHS has defined requested rate increases of 10 percent or more as the threshold triggering greater scrutiny.8 Insurance companies requesting such an increase must submit, both to HHS and their state regulator, a justification for such request.  Reviewing data collected from the Rate Justification Program, HHS found that in both the individual and small group markets, approximately 28 percent of all rate increase requests of 10 percent or more were modified or rejected (see Appendix tables A-1 and A-2).

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