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5 Key Health Care Provisions Finalized

A final rule that implements five key consumer protections from the Affordable Care Act were issued by the U.S. Department of Health and Human Services (HHS).  

“Because of the Affordable Care Act, being denied affordable health coverage due to medical conditions will be a thing of the past for every American,” said HHS Secretary Kathleen Sebelius. “Being sick will no longer keep you, your family, or your employees from being able to get affordable health coverage.”

Under these reforms effective January 1, 2014, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

Today’s final rule implements five key provisions of the Affordable Care Act that are applicable to non-grandfathered health plans:

  • Guaranteed Availability
    Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
  • Fair Health Insurance Premiums
    Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography. Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
  • Guaranteed Renewability
    Health insurance companies will no longer refuse to renew coverage because an individual or an employee has become sick. You may renew your coverage at your option.
  • Single Risk Pool
    Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single state-wide risk pool for the individual market and single state-wide risk pool for the small group market.
  • Catastrophic Plans
    Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

These protections come at a cost that critics say will initially cause large increases in premiums. Placing millions of uninsured and chronically ill people on insurance will load the system with high claims expense; capping premiums at no more than a 3 to 1 ratio from oldest to youngest beneficiaries will raise the premium levels of all younger insureds;  guaranteed renewability is already a common provision for health insurance; single risk pools will quickly become “dead pools” at very high premium levels because insurers can’t underwrite new enrollees and their pool can quickly become unbalanced and poisoned by too many chronically ill; catastrophic plans are also currently a common offering in many states.  

Anticipating rate issues the final rule amends certain provisions of the rate review program in preparation for the market changes in 2014 and streamlines data collection for insurers and states.  And, HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests. A new report has found that the law’s transparency provisions have already resulted in a decline in double-digit premium increases filed: from 75 percent in 2010 to, according to preliminary data, 14 percent in 2013.

In addition, today the U.S. Department of Labor announced an interim final rule in the Federal Register that provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a tax credit or cost-sharing reduction as a result of participating in a Health Insurance Exchange, or Marketplace. Additional information is available at or

For more information on this final please visit:

For information on the rights and protections guaranteed by the health care law, please visit:

For the full text of the proposed rule, please visit:

Source: Health and Human Services (HHS), News Release - February 22, 2013


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