Two Final Federal Regulations Announced: Health Insurance Market Rules/Rate Review; and, Regulations on Standards Related to Essential Health Benefits


The Department of Health and Human Services (HHS) has announced the release of final federal regulations implementing provisions of the Affordable Care Act (ACA) as they relate to health insurance market rules and rate review [pdf], and standards related to essential health benefits [pdf].

Of important note regarding the regulation on market rules and rate review, HHS states that student health insurance coverage is not subject to the single risk pool requirement of the Affordable Care Act, and that the premium rate charged by an issuer offering student health insurance coverage may be based on a school-specific group community rating. HHS also finalized its decision to exempt student health insurance coverage from the guaranteed availability and the guaranteed renewability requirements of the Public Health Service Act. The Department affirmed that special and open enrollment periods do not apply to issuers of student health insurance coverage; therefore, student health insurance issuers can work with colleges and universities to determine appropriate enrollment periods for student enrollees and their dependents.

ACHA will be examining these finalized regulations in further detail to determine their potential effect on student health insurance coverage going forward. Additionally, we will continue to monitor developments and seek to influence other issues related to ACA implementation that affect students’ options for comprehensive and affordable student health coverage.