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Under rules issued in June that take effect for plan years beginning on or after Sept
. 23, 2010, insurers may no longer exclude pre-existing conditions from coverage for enrollees under the age of 19. In an effort to address concerns regarding adverse selection, HHS issued guidance July 27 authorizing insurers to restrict enrollment of children under age 19 "to specific open-enrollment periods," if permitted by state law. But the open-enrollment period must apply to healthy as well as sick children, while the insurers and some state insurance commissioners, preferred to allow acceptance of healthy children year-round. HHS signaled that it would try to adjust open-enrollment periods to address the risk of adverse selection, but no deal had been reached by press time.Meanwhile, insurers in several states blamed reform for premium rate hikes. The Rhode Island Blues plan, for example, reportedly told customers it would raise premiums by a few percentage points on top of already approved rate hikes to account for additional benefits mandated by the reform law. BCBSRI and other Rhode Island insurers that planned to impose similar rate hikes came under fire from Insurance Commissioner Christopher Koller. In a Sept. 9 letter to chief executives at the state's three largest insurers, Koller said that any changes to approved premium rates "as a result of PPACA [i.e., the reform law] will be considered material and an exception to the OHIC's previous decision.They may not to be applied in quotes to customers unless and until approved by this office." The insurers also must submit "analysis supporting the additional premium rate charge anticipated for each contemplated change and why it should cause average rates to increase by more than the amount approved."
BCBSRI spokesperson Kimberly Reingold told The AIS Report that "the guidelines under federal health care reform will add cost to employers and we currently are working with them to understand the specific impact to premiums, which will vary based upon benefits selected by each employer. Every time an employer changes their coverage, or we are mandated to cover new servicesrates are adjusted." She added that "those rates could be anywhere from 1.8% to 3% more depending upon plan design."
HHS reacted strongly to news that insurers were blaming reform for rate hikes and market exits. In a Sept. 9 letter to the trade group America's Health Insurance Plans, HHS Sec. Kathleen Sebelius warned that there will be zero tolerance for "misinformation and unjustified rate increases" blamed on health reform. In her letter, Sebelius said that several insurers are falsely attributing 2011 premium increases to patient protections in the reform law. According to the administration's analysis and those of some "industry and academic experts," any potential premium impact from reform would be no more than 1% or 2%.
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