1. Virginia’s Health Insurance Rate Regulations Pre- and Post-ACA
Prior to July 1, 2013
Only individual non-HMO, non-association required prior approval from the Commission’s BOI
60% minimum loss ratio
July 1, 2013 and later
All individual and all small group, including HMO and associations, require prior approval from the Commission’s BOI
75% minimum loss ratio
ACA market rules (rating, GI, single risk pool, AV, EHB)
Due to new legislation, Virginia was deemed to be a fully effective rate review state by the Center for Consumer Information and Insurance Oversight (CCIIO), part of the federal department of Health and Human Services

2. Virginia Individual - Rating Variables
Pre-2014 Common Variables
Post-2014 Allowed Variables
(ACA and VA conforming legislation)
Age, with no limitations
Gender
Geographic location with carrier customization
Health status including denial of coverage
Member level rating
Age, no more than 3:1
Gender
Geographic location with areas established by HHS
Health status including denial of coverage
Tobacco rating, no more than 1.5:1
Member level rating

3. Virginia Small Group - Rating Variables
Pre-2014 Common Variables
Post-2014 Allowed Variables
(ACA and VA conforming legislation)
Age, with no limitations
Gender
Geographic location with carrier customization
Health status (must GI group)
Industry
Group size
Contribution/Participation
Age, no more than 3:1
Gender
Geographic location with areas established by HHS
Health status (must GI group)
Industry
Group size
Contribution/Participation
Tobacco rating, no more than 1.5:1 (must be able to avoid with wellness program)
Member level rating

4. New Benefit and Cost-Sharing Requirements for 2014 (ACA and VA Conforming Legislation)
All individual and small group plans must cover, at a minimum, Essential Health Benefits (EHBs)
EHBs are not changing for 2016
All individual and small group plans must have cost-sharing that provides a minimum of 60% Actuarial Value (AV)
Indicator of relative plan generosity, similar to a car’s MPG rating
Plans must fall into one of four metal levels (platinum, gold, silver, bronze)
Catastrophic plans* can be offered in the individual market; AV can be slightly lower than 60%, must cover all EHBs and maximum out-of-pocket cannot exceed $6,350 in 2014.
* Available only to individuals up to age 30, or those who are exempt based on affordability or hardship.

5. Annual Maximum Out-of-Pocket Limits
Annual Maximum Out-of-Pocket Limits* * All costs the consumer is expected to pay, including deductibles, co-pays, coinsurance; does not include premiums
Year
Individual
Family
2014
$6,350
$12,700
2015
$6,600
$13,200
2016
$6,850
$13,700
2017
$7,150
$14,300

6. Overview Market 2015 2016 2017 No. of Carriers Avg. Rate Change
Individual On-Exchange 9
+8.4% 11
+11.0%
+19.5%
Individual Off-Exchange 6
+13.7% 5
+12.1% 3
+17.5%*
Small Group On-Exchange
+4.4%
+3.3%
+8.6%
Small Group Off-Exchange 18
+6.6% 13
+5.6%
+11.8%*
Increases only reflect premium increases, not changes in cost-sharing
* Off-Exchange rates not final

7. The ACA Risk Corridor Program
Temporary program (2014 – 2016) to help stabilize premiums due to under- or over-pricing
Carriers who make more than a targeted amount pay into the program; carriers making less receive money from the program
Congress made it revenue neutral (pay outs must equal pay ins)
As such, carriers received 12.6% of their required payment for 2014
CMS recently announced that any shortfall from 2014 will be made up with 2015 payments, prior to any money taken in for 2015