Zane Benefits Publishes New Information on Health Insurance Market Reforms

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U.S. Department of Health and Human Services Released Final Rule to Implement Key Provisions of Affordable Care Act (ACA).

Today, Zane Benefits, Inc. published new information on health insurance market reforms. Zane Benefits, which provides comprehensive and flexible alternatives to traditional employer sponsored health benefits, is the leader in defined contribution and health reimbursement arrangements.

According to Zane Benefits’ website, the U.S. Department of Health and Human Services released a final rule on February 22, 2013 that implements key provisions of the Affordable Care Act (ACA), including the requirement to cover people with pre-existing conditions. The final rule further implements the following five provisions of ACA that are applicable to non-grandfathered health plans:

Guaranteed Issue

According to Zane Benefits’ website, effective January 1, 2014, individual health insurance plans will be guaranteed issue subject to open and special enrollment periods in the individual market. In other words, health insurance companies will be prohibited from denying coverage to people because of a pre-existing condition or any other health factor. In addition, individuals will have special enrollment opportunities in the individual market when they experience certain significant life changes, similar to those in the group market today.

Fair Health Insurance Premium Rating

According to Zane Benefits’ website, effective January 1st, 2014, health insurance companies offering coverage to individuals and small employers can vary premiums based on age, tobacco use, family size and geography. The rule implements the age rating at no greater than 3:1 and tobacco use rating at 1.5:1.

States can choose to enact stronger consumer protections than these minimum standards. In addition, starting in 2017, states have the option of allowing health insurance issuers that offer coverage in the large group market to offer such coverage through the marketplace. For states that choose this option, these rating rules also will apply to all large group health insurance coverage. These rules standardize how health insurance issuers can price products, bringing a new level of transparency and fairness to premium pricing.

Guaranteed Renewability

According to Zane Benefits’ website, the final rule reaffirms existing protections that individuals and employers have with respect to coverage renewal. For example, these protections will prohibit issuers from refusing to renew coverage because an individual or employee becomes sick or has a pre-existing condition. In other words, health insurance companies must renew coverage subject to certain exceptions such as non-payment of premium.

Single Risk Pool

According to Zane Benefits’ website, insurers are required to maintain a single statewide risk pool for claims experience in the individual market and single statewide risk pool for the small group market, unless a state chooses to merge the individual and small group pools into one pool. The single risk pool provision prevents insurers from segmenting enrollees into separate rating pools in order to increase premiums at a faster rate for higher-risk individuals more than lower-risk individuals, as is often the practice today. Premiums and annual rate changes will be based on the health risk of the entire pool.

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About Zane Benefits

Zane Benefits was founded in 2006 to provide a revolutionized SaaS (Software-as-a-Service) administration platform ("ZaneHRA") for Health Reimbursement Arrangements (HRAs) and defined contribution health care. The flagship software provides a 100% paperless administration experience to employers and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, visit

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Christina Merhar
Zane Benefits
800-391-9209 6725
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