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Home Employers Industry Insights for Employers and Brokers Informed on ReformMarket Rules Under the Affordable Care Act

Market Rules Under the Affordable Care Act

Under the Affordable Care Act (ACA), Market Rules ensure that individuals and employers will have a minimum set of protections for health insurance access and premium stability in all states, inside and outside of the Health Insurance Marketplace.

This is a summary of the ACA Market Rules as they relate to Guaranteed Availability, Guaranteed Renewability, Single Risk Pool and Rating Standards provisions.

The provisions within the chart below are effective for plan years beginning on or after January 1, 2014.

EHB categories

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Guaranteed availability/guaranteed renewability

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Single risk pool

  • Insurers cannot use separate risk pools to charge certain customers higher rates. Insurers must use the total combined claims experience of all their non-grandfathered individual or small group plans in a state to establish an index rate (average rate) for that market.
  • This index rate will be used to set rates for all of the insurer’s products in that market.

Rating standards

This chart provides more details about each of the four rating factors.

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Effective July 16, 2014, the guaranteed availability, guaranteed renewability and single risk pool provisions no longer apply to insured plans issued in the U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands).

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Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

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