Sec. 101 Medical loss ratio
Section 2718(b)(1)(A)(ii) of the Public Health Service Act (42 U.S.C. 300gg–18(b)(1)(A)(ii)) is amended by striking “80” each place it appears and inserting “85”.
Title I — Limiting insurer profits and preventing unreasonable premium increases
I Limiting insurer profits and preventing unreasonable premium increases
Sec. 102 Ensuring that consumers get value for their dollars
The first section 2794 of the Public Health Service Act (42 U.S.C. 300gg–94), added by section 1003 of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended—
in subsection (a)—
in paragraph (1), by striking “subsection (b)(2)(A)” and inserting “subsections (b)(2)(A) and (b)(3)”; and
in paragraph (2), by adding at the end the following: “Notwithstanding any other provision of law, a health insurance issuer may not exclude from such disclosure information that is a trade secret or commercial or financial information described in section 552(b)(4) of title 5, United States Code.”;
in subsection (b)—
in paragraph (2)(A), by inserting “and paragraph (3)” after “subsection (a)(2)”; and
by adding at the end the following:
“(3) Prohibiting unreasonable premium increases
“(A) In general—Beginning with plan years beginning in 2021, the Secretary, or a State pursuant to an effective rate review program meeting the requirements under paragraph (4)—
“(i) shall, consistent with subsection (a)(2) and paragraph (2), review increases in premiums for health insurance coverage that are subject to review pursuant to section 154.200 of title 45, Code of Federal Regulations (or any successor regulation), and determine whether such increases are unreasonable; and
“(ii) may prohibit a health insurance issuer from implementing such an increase that is unreasonable.
“(B) Unreasonable increases—In determining whether an increase in premiums for health insurance coverage is unreasonable under subparagraph (A)(i)—
“(i) the Secretary shall consider whether the increase is excessive, unjustified, discriminatory, or inadequate; and
“(ii) the State, pursuant to an effective rate review program meeting the requirements under paragraph (4), shall apply applicable State law for making such determination.
“(4) State effective rate review programs—A State effective rate review program meets the requirements under this paragraph if—
“(A) the program carries out the reviews described in paragraph (3)(A)(i) and ensures that such reviews are meaningful, effective, and timely reviews of the data and documentation (including any contracts or documents described in subparagraph (E)) submitted by health insurance issuers in support of proposed increases in premiums for health insurance coverage;
“(B) such reviews include an examination of—
“(i) the affordability of proposed increases in premiums for health insurance coverage;
“(ii) the quality improvement activities carried out by health insurance issuers proposing the increases;
“(iii) the cost containment activities of health insurance issuers proposing the increases; and
“(iv) the solvency of the health insurance coverage;
“(C) the program establishes a mechanism for receiving public comments on proposed increases in premiums for health insurance coverage reviewed by the State;
“(D) such reviews include a review of all public comments received under subparagraph (C);
“(E) the program requires each health insurance issuer proposing an increase in premiums for health insurance coverage to submit to the State any provider contracts that may be affected, including any documents incorporated by reference into such contracts; and
“(F) the program requires the State to provide the Secretary its determination of whether each increase reviewed is unreasonable, in a form and manner prescribed by the Secretary.”
in subsection (c)—
in paragraph (1)—
in the heading, by striking “2010 through 2014” and inserting “2021 through 2025”; and
in the matter preceding subparagraph (A), by striking “2010” and inserting “2021”; and
in paragraph (2)(B), by striking “2014” and inserting “2025”.
Sec. 103 Effective date
The amendments made by this title shall apply to plan years beginning after December 31, 2020.