Final Rate Determination

The Florida Administrative Code requires that all individual and small group carriers obtain approval of their premium rates from the Florida Office of Insurance Regulation (OIR). In addition, the Patient Protection and Affordable Care Act (ACA) requires that all weighted average rate increases in the individual and small group markets that exceed a stipulated threshold (currently 15%), must be assessed to determine if they are "reasonable". For individual and small group carriers issuing coverage in the state of Florida, the federal enforcement agency for the Patient Protection and Affordable Care Act, the U.S. Department of Health and Human Services (HHS), has delegated the authority to determine if rate increases are reasonable to the OIR.

Currently, all Florida Blue, Florida Blue HMO, and Truli for Health rate increases for individual and small group products do not exceed the threshold.


Rate Increase Justification

This rate action is for all BlueOptions, BlueSelect, BlueCare, myBlue, SimplyBlue, and Truli for Health products that are fully compliant with the ACA.

The proposed rate action is due to the following reasons:

  • Medical Inflation (Trend)
    • Medical Trend: Combined effect of medical provider price increases, utilization changes, medical cost shifting, specialty pharmacy, and new medical procedures and technology.
    • Insurance Trend: Impact of leveraging on plans with fixed dollar cost shares.
  • Prospective changes to covered benefits
    • Adjustment to cover preventive services recently added to the US Preventive Services Task Force (USPSTF)
  • Risk Adjustment Transfer
    • Changes in 2021 to the CMS Risk Adjustment coefficients
    • Additions to Hierarchical Condition Category (HCC) codes in 2021
  • Taxes and Fees
    • Removal of the Health Insurance Providers Fee for 2021
    • Increase in the Risk Adjustment User Fee
    • Reintroduction of the Patient-Centered Outcomes Research Institute (PCORI) fee
  • Adjustment to account for cost savings initiatives