Regulations and Guidance

The Office of Consumer Information and Insurance Oversight will work with the Department of Health and Human Services to issue regulations and implement many of the provisions of the legislation that address private health insurance. Visit this page frequently for links to proposed regulations, requests for comment, and other updates.

Regulations 

Medical Loss Ratio

Health Insurance Exchanges

New Consumer Protections Begin

Affordable Care Act implementation frequently asked questions

Amendments to the HIPAA opt-out provision

Children Under 19
These questions and answers will assist issuers with implementation of the requirement that for non-grandfathered individual health insurance policies, children under 19 cannot be denied coverage because of a pre-existing condition for policy years beginning on or after September 23, 2010.

Consumer Health Plan Appeals
New rules give consumers the right to appeal decisions by their health plans.

Dependent Coverage of Children Who Have Not Attained Age 26  
The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage available until a child reaches the age of 26. This rule applies to all plans in the individual market and to new employer plans.

Early Retiree Reinsurance Program 
The program provides reimbursement to sponsors of participating employment-based plans for a portion of the cost of health benefits for early retirees and their spouses, surviving spouses, and dependents. The purpose of the reimbursement is to make health benefits more affordable for plan participants and sponsors so that health benefits are accessible to more Americans than they would otherwise be without this program.

Prevention
Under the Affordable Care Act, many insurers are required to cover certain evidence-based preventive services at no cost to you. Services include screenings, consultations, immunizations and more.

Regulation on “Grandfathered” Health Plans under the Affordable Care Act 
The new regulation protects the ability of individuals and businesses to keep their current plan while providing important consumer protections. The new regulation also provides stability and flexibility to insurers and businesses that offer health insurance coverage as the nation transitions to a more competitive marketplace in 2014 when businesses and consumers will have more affordable choices through exchanges. 

Health Care Reform Insurance Web Portal Requirements 
This interim final rule adopts the categories of information that will be collected and displayed via the web portal required by the Affordable Care Act.  Through this website, individuals and small businesses can obtain information about the insurance coverage options that may be available to them in their State.

Patient’s Bill of Rights 
These new protections create an important foundation of patients’ rights in the private health insurance market that puts Americans in charge of their own health.

Pre-Existing Condition Insurance Plan
Regulations announced July 30 establish standards necessary for the administration of the program and clarify certain issues not otherwise specified in the statute.

Annual Limit Waivers 

Requests for Comment 

Health Insurance Exchanges: Starting in 2014, improved choices will be offered through health insurance Exchanges – new, competitive, state-run and consumer-centered health insurance marketplaces.  The Exchanges will make purchasing health insurance easier by providing eligible consumers and businesses with “one-stop-shopping” where they can compare and purchase health insurance coverage.  The Department of Health and Human Services is asking States, consumer advocates, employers, insurers, and other interested stakeholders to comment on the types of standards Exchanges should be required to meet.

Medical Loss Ratios: The Departments of Health and Human Services, Labor and Treasury invited public comment to aid in the development of regulations regarding Section 2718 of the PHS Act. Section 2718 requires health insurance issuers offering individual or group coverage to submit annual reports to the Secretary on the percentages of premiums that the coverage spends on reimbursement for clinical services and activities that improve health care quality, and to provide rebates to enrollees if this spending does not meet minimum standards for a given plan year.

Premium Review Process; Request for Comments Regarding Section 2794 of the Public Health Service Act: The Department of Health and Human Services invited public comments regarding Section 2794 to the Public Health Service Act.  Section 2794 requires the Secretary to work with States to establish an annual review of unreasonable rate increases, to monitor premium increases and to award grants to States to carry out their rate review process.