---
kind: "section"
citation: "45 C.F.R. § 154.102"
title: "45"
number: "154.102"
heading: "Definitions."
url: "https://uscodex.org/cfr/45/154.102"
---

# §154.102. Definitions.


As used in this part:

CMS means the Centers for Medicare & Medicaid Services.

Effective Rate Review Program means a State program that CMS has determined meets the requirements set forth in § [154.301(a)](/cfr/45/154.301.md?p=a) and [(b)](/cfr/45/154.301.md?p=b) for the relevant market segment in the State.

Federal medical loss ratio standard means the applicable medical loss ratio standard for the State and market segment involved, determined under [subpart B](/cfr/45/subpartB.md) of [45 CFR part 158](/cfr/45/part158.md).

Health insurance coverage has the meaning given the term in [section 2791(b)(1)](/cfr/45/2791.md?p=b-1) of the PHS Act.

Health insurance issuer has the meaning given the term in [section 2791(b)(2)](/cfr/45/2791.md?p=b-2) of the PHS Act.

Individual market has the meaning given the term in [§ 144.103](/cfr/45/144.103.md) of this subchapter.

Plan has the meaning given the term in [§ 144.103](/cfr/45/144.103.md) of this subchapter.

Product means a package of health insurance coverage benefits with a discrete set of rating and pricing methodologies offered in a State. The term product includes any product that is discontinued and newly filed within a 12-month period when the changes to the product meet the standards of § [147.106(e)(2)](/cfr/45/147.106.md?p=e-2) or [(3)](/cfr/45/147.106.md?p=e-3) of this subchapter (relating to uniform modification of coverage).

Rate increase means, with respect to rates filed—

- (1) For coverage effective prior to January 1, 2017, any increase of the rates for a specific product offered in the individual or small group market.
- (2) For coverage effective on or after January 1, 2017, any increase of the rates for a specific product or plan within a product offered in the individual or small group market.

  Rate increase subject to review means a rate increase that meets the criteria set forth in [§ 154.200](/cfr/45/154.200.md).

  Secretary means the Secretary of the Department of Health and Human Services.

  Small group market has the meaning given the term in [§ 144.103](/cfr/45/144.103.md) of this subchapter.

  State means each of the 50 States and the District of Columbia.

  Unreasonable rate increase means:

- (1) When CMS is conducting the review required by this part, a rate increase that CMS determines under [§ 154.205](/cfr/45/154.205.md) is:
  - (i) An excessive rate increase;
  - (ii) An unjustified rate increase; or
  - (iii) **An unfairly discriminatory rate increase.**
- (2) When CMS adopts the determination of a State that has an Effective Rate Review Program, a rate increase that the State determines is excessive, unjustified, unfairly discriminatory, or otherwise unreasonable as provided under applicable State law.

## Notes

### Amendments

[76 FR 29985, May 23, 2011, as amended at 76 FR 54976, Sept. 6, 2011; 79 FR 30342, May 27, 2014; 80 FR 10863, Feb. 27, 2015; 81 FR 94175, Dec. 22, 2016]

### Authority

Authority: Section 2794 of the Public Health Service Act (42 USC 300gg-94).

### Source

Source: 76 FR 29985, May 23, 2011, unless otherwise noted.

### Amendments

[76 FR 29985, May 23, 2011, as amended at 76 FR 54976, Sept. 6, 2011; 79 FR 30342, May 27, 2014; 80 FR 10863, Feb. 27, 2015; 81 FR 94175, Dec. 22, 2016]