Rate Review Data

Background

Section 2794(a)(1) of the Public Health Service (PHS) Act requires the Secretary, in conjunction with States, to establish a process for the annual review of unreasonable premium increases for health insurance coverage. Section 2794(a)(2) of the PHS Act requires health insurance issuers to submit to the Secretary and relevant State a justification for an unreasonable premium increase prior to implementation.  Most states have an effective rate review program and will review rate increases submitted by health insurance issuers in their states. CMS will review rate increases in the market(s) where states do not have an effective rate review program. For single risk pool filings a rate increase is subject to reasonableness review if the average increase meets or exceeds the threshold specified in 45 C.F.R. 154.200.

A health insurance issuer must submit a Rate Filing Justification for each plan in the single risk pool. This Rate Filing Justification consists of the following parts:

Part I, Uniform Rate Review Template: A form that summarizes the data used to determine rate increases for the entire single risk pool. CCIIO is also making the data in this form available on the CCIIO website for public use.

Part II, Written Explanation of the Rate Increase: A simple and brief narrative describing the data provided in Part I for any product(s) within the single risk pool which have rate increases subject to review, and the assumptions used to develop the rate increase, including an explanation of the most significant factors causing the rate increase.

Part III, Actuarial Memorandum:Rate filing documentation that states and CMS use to understand the actuarial assumptions, justifications and methodologies used to comply with the market rating rules and to complete the Part I template.

This page contains links to the rate review data posted on the CCIIO website.  Please email ratereview@cms.hhs.gov with questions regarding the rate review information that is posted on this website or to submit comments on proposed increases.

Data

Preliminary Justification for Non-Single Risk Pool Plans

• Search tool for Parts I and II Preliminary Justification Information
  This page contains a search tool to find non-single risk pool compliant Parts I and II Preliminary Justification information by state and issuer. Select “Search Transitional Products” to search for non-single risk pool products.
• Search tool for Part III Preliminary Justification Information
  This page contains a search tool to find non-single risk pool compliant Part III Preliminary Justification Documentation by state and issuer for submissions in the five states where CMS performs the rate review.

Rate Filing Justification for Single Risk Pool Plans

• Search tool for Parts I, II, and III Rate Filing Justification Information
  This page contains a search tool to find single risk pool compliant Parts I and II Rate Filing Justification information by state and issuer. For plans effective on or after January 1, 2016, the search tool also contains Part III Rate Filing Justification information. Select “Search ACA-Compliant Products” to search for single risk pool products.
• Public Use File for Single Risk Pool Plans
  The PUF includes the single risk pool filing information found in Part I of the Rate Filing Justification as well as other data fields such as the review status. The zip file provides the Part I data in .csv format and also includes a data dictionary. These files will be updated periodically.
  • Worksheet I and II Data for 2014 Single Risk Pool Filings (ZIP) (Updated November 4, 2016)
  • Worksheet I and II Data for 2015 Single Risk Pool Filings (ZIP) (Updated November 4, 2016)
  • Worksheet I and II Data for 2016 Single Risk Pool Filings (ZIP) (Updated November 4, 2016)
  • Worksheet I and II Data for 2017 Single Risk Pool Filings (ZIP)  (Updated October 25, 2017)
  • Worksheet I and II Data for 2018 Single Risk Pool Filings (ZIP)  (Updated January 3, 2018)
  • Worksheet I and II Data for 2019 Single Risk Pool Filings (ZIP)  (Updated October 26, 2018)
  • Worksheet I, II and III Data for 2020 Single Risk Pool Filings (ZIP)  (Updated November 25, 2020)
  • Worksheet I, II and III Data for 2021 Single Risk Pool Filings (ZIP)  (Updated November 25, 2020)
  • Worksheet I, II and III Data for 2022 Single Risk Pool Filings (ZIP) (Updated February 7, 2022)
  • Worksheet I, II and III Date for 2023 Single Risk Pool Fillings (ZIP) (Updated November 1, 2022)
  • Worksheet I, II, and III Data for 2024 Single Risk pool Filings (ZIP) (Updated November 12, 2023)