Patient Protection and Affordable Care Act; standards related to reinsurance, risk corridors, and risk adjustment. Final rule

Fed Regist. 2012 Mar 23;77(57):17220-52.


This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with title I of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges ("Exchanges") are implemented, starting in 2014. The transitional State-based reinsurance program serves to reduce uncertainty by sharing risk in the individual market through making payments for high claims costs for enrollees. The temporary Federally administered risk corridors program serves to protect against uncertainty in rate setting by qualified health plans sharing risk in losses and gains with the Federal government. The permanent State-based risk adjustment program provides payments to health insurance issuers that disproportionately attract high-risk populations (such as individuals with chronic conditions).

MeSH terms

  • Chronic Disease / economics
  • Community Participation / economics
  • Community Participation / legislation & jurisprudence
  • Economic Competition / economics
  • Economic Competition / legislation & jurisprudence
  • Federal Government
  • Insurance Carriers / economics
  • Insurance Carriers / legislation & jurisprudence*
  • Insurance Selection Bias
  • Patient Protection and Affordable Care Act / economics*
  • Patient Protection and Affordable Care Act / legislation & jurisprudence
  • Rate Setting and Review / legislation & jurisprudence
  • Risk Sharing, Financial / economics
  • Risk Sharing, Financial / legislation & jurisprudence*
  • Risk Sharing, Financial / standards
  • State Government