The Governor’s Office of Health Care Reform

April 24, 2013

Statement from the Governor’s Office of Health Care Reform on Carriers’ Insurance Form and Rate Filings

In response to the filings posted by the Maryland Insurance Administration today, which show rates carriers have proposed for plans to be offered on the Maryland Health Connection, the state-based health insurance marketplace to be operated by the Maryland Health Benefit Exchange beginning October 1, 2013, Carolyn Quattrocki, Director of the Governor’s Office of Health Care Reform, issued the following statement:

“The proposed rates made public today are just that – proposed. The Commissioner, under her expansive authority to review and modify rates, will now undertake a thorough and comprehensive scrutiny of the carriers’ requests. We must await the outcome of that process, during which the Commissioner and her staff will conduct actuarial analyses, test assumptions and projections, and work with carriers to arrive at appropriate rates. It is premature to reach any judgment or conclusion based on the rates as proposed. In the meantime, we are pleased that the filings confirm there will be robust participation in the Maryland Health Connection.”

Fact Sheet on Insurance Coverage under the Affordable Care Act  Stronger Consumer Protections – “Patients’ Bill of Rights”
• Too often, people pay insurance premiums for years only to be let down when they finally need significant health care services:

• Serious illness can rapidly push patients’ claims above annual or lifetime limits and land them in bankruptcy, or cost-sharing becomes unaffordable.

• Patients’ conditions turn out not to be covered by their policies, or coverage is dropped altogether because of an error made in an application.

• Individuals are charged more because of a disability or illness, or cannot get coverage at all.

• The Affordable Care Act makes sure that, as more people gain access to coverage, the insurance they purchase will actually provide the protection they need when they get sick.

• In January 1, 2014, all small employer and individual plans will be subject to the following requirements:

• Out-of-pocket costs for consumers will be capped at about $6,350 for an individual and $12,700 for a family, with lower caps for people below 400% FPG. Preventive services will be provided at no cost.

• Plans will be required to cover a minimum set of essential health benefits, including maternity and newborn care, prescription drugs, behavioral health, and preventive/wellness services.

• Plans may not impose annual or lifetime limits on claims, or revoke insurance when someone gets sick.

• No one will be denied insurance because of a pre-existing condition, or charged more based on gender or health status.

Affordability Mechanisms

• The Affordable Care Act provides individuals, families, and small employers federal subsidies and cost-sharing assistance to help them afford coverage through the health benefit exchange.

• Individuals and families between 133-400% of federal poverty guidelines (FPG) will receive tax credits so that, on a sliding scale, they will pay no more than 2.0% – 9.5% of their income for insurance.

• Individuals and families between 133-250% FPG will receive assistance with their out-of-pocket costs for co-payments and other cost-sharing.

• Small employers will receive up to 50% of their contribution to their employees’ premiums.

• Seniors will receive discounts on prescription drugs, which will increase over time to close the “donut hole” by 2020.

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