Final Rate Determination

The Florida Insurance 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), otherwise known as Health Care Reform, 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, Health and Human Services (HHS), has delegated the authority to determine if rate increases are reasonable to the OIR.

Currently, all Florida Blue and Florida Blue HMO’s rate increases for individual and small group products either do not exceed the threshold, or have been determined to be "reasonable."

Rate Increase Justification

This rate action is proposed for all BlueOptions, BlueSelect, BlueCare, myBlue, and SimplyBlue products that are fully compliant with the Patient Protection and Affordable Care Act (PPACA).

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, and new medical procedures and technology.
    • Insurance Trend: Impact of leveraging on plans with fixed dollar cost shares.
  • Addition of coverage for Essential Health Benefits (EHBs)
    • New benefit mandates under the United States Preventive Services Task Force (USPSTF) for $0 cost share on certain preventive measures
  • Risk Adjustment Transfer
    • Changes in 2019 to the CMS Risk Adjustment Transfer formula
  • Cost Share Reduction Payments
    • On-Marketplace Individual Silver plans are no longer receiving Cost Share Reduction payments from the Federal Government
  • Taxes and Fees
    • One-year suspension of the Health Insurance Providers Fee
    • Removal of the Patient Centered Outcomes Research Institute fee
    • oIncrease in the Risk Adjustment User Fee