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State Adoption of Select 2010 and 2014 Affordable Care Act Provisions

(as of December 5, 2016)

Background: without variation in premiums based on their gender or


medical history;
The Affordable Care Act (ACA) required the implementation  limiting the age band to 3:1;
of several market reforms by September 23, 2010. These  allowing rate band of 1.5:1 for individuals who smoke; and
include:  requiring health plans offered within an Exchange as well
 rescissions only for fraud or intentional misrepresentation; as plans sold in states’ individual and small group and
 coverage of dependents to age 26; markets to provide coverage for “essential health benefits”
 prohibitions on annual and lifetime limits for essential (EHBs).
health benefits;
 choice of primary care providers; Some states have adopted the same or similar ACA market
 direct access to OB/GYNs and pediatricians; reform requirements by statute or regulation or have issued
 coverage of preventive services without cost sharing; bulletins addressing these provisions.
 internal claims appeal process; and
 external review procedures. Summary of State Adoption of ACA 2010 Market Reforms:
 State Adoption: Generally, the majority of states adopt the
The ACA also outlines broad market reforms that take effect specific 2010 market reform provisions described in the
January 1, 2014. These include: chart below.
 the imposition of an individual mandate;  Six states (AK, AZ, HI, ME, NC, and VT) adopt the
 guaranteeing individuals purchasing insurance in the 2010 ACA market reform provisions with blanket
individual market coverage for pre-existing conditions, reference to the ACA and/or federal law.

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 Three states (DE (for rating), MD, and UT) adopt  Seventeen states (AK, AZ, CO, CT, HI, ME, MD, MN,
the 2010 ACA market reform provisions with NY, NC, OR, SD, UT, VT, VA, WA (for QHPs), and WI)
specific reference to the ACA market reform have established provisions prohibiting the use of annual
provisions. limits for essential health benefits consistent with the ACA.

 Effect of Repeal of the ACA: AK, AZ, DE and SD Prohibitions on lifetime limits for essential health benefits:
includes specific language that would repeal the specified  Seventeen states (AK, AZ, CO, CT, HI, ME, MD, MN,
2010 provisions should the reforms be found NY, NC, OR, SD, UT, VT, VA, WA (for QHPs), and WI)
unconstitutional by the U.S. Supreme Court or a final have established provisions prohibiting the use of lifetime
decision by a federal court of competent jurisdiction with limits for essential health benefits consistent with the ACA.
appeals exhausted or the time for appeal elapsed.
Choice of primary care provider:
Rescissions only for fraud or intentional misrepresentation:  Fifteen states (AK, AZ, CO, CT, HI, ME, MD, MN, NY,
 Nineteen states (AK, AZ, CO, CT, DE, HI, KS, LA, ME, NC, SD, UT, VT, VA, and WA (for QHPs)) have
MD, MN, NY, NC, OR, SD, UT, VT, and VA) and DC established provisions allowing the designation of any
have established requirements or issued bulletins allowing willing participating pediatrician as the primary care
rescissions only for fraud or intentional misrepresentation provider consistent with the ACA.
consistent with the ACA.
Access to obstetrical and gynecological services:
Dependent coverage to age 26:  Sixteen states (AK, AZ, CO, CT, HI, ME, MD, MN, NY,
 Twenty-seven states (AK, AZ, CA, CO, CT, DE, HI, IN, NC, OR, SD, UT, VT, VA, and WA (for QHPs)) have
KY, LA, ME, MD, MI, MN, MT, NV, NH, NY, NC, ND, established requirements for coverage of gynecological and
OR, SD, UT, VT, VA, WA, and WI) and DC have obstetric care by a network gynecologist or obstetrician
established requirements for providing coverage for without prior authorization or referral consistent with the
dependents up to age 26 consistent with the ACA.1 ACA.

Prohibitions on annual limits for essential health benefits: Access to pediatric services:
 Fifteen states (AK, AZ, CO, CT, HI, ME, MD, MN, NY,
NC, SD, UT, VT, VA, and WA (for QHPs)) have
1 Note that many other states have dependent coverage provisions enacted prior to established provisions allowing for the designation of any
the ACA that require coverage for ages 26 and older.
2
willing participating pediatrician as the primary care insurance policy forms and filings to contain all or most of the
provider for a child consistent with the ACA. above ACA market reform provisions, but most of these states
(AL, AR, FL, GA, IL, KY (except for dependent coverage),
Preventive services without cost sharing: LA (except for rescissions and dependent coverage), MN, MO,
 Eighteen states (AK, AZ, CA, CO, CT, DE, HI, ME, MD, NE, NH, NJ (except for internal appeals), NM, ND (except for
MN, NY, NC, OR, SD, UT, VT, VA, and WA (for QHPs)) dependent coverage and internal appeals), SC, TX, and WI
have established requirements for coverage of preventive (except for dependent coverage and lifetime limits)) took no
services without cost sharing consistent with the ACA. further action to adopt any the ACA requirements.

Internal claims appeals: In addition, a few states (e.g., HI, IA, NH, NC, and ND) also
 Twenty-three states (AK, AZ, CO, CT, DE, HI, LA, ME, provide state insurance commissioners with the authority to
MD, MN, MT, NV, NJ, NY, NC, ND, OR, SD, UT, VT, enforce provisions or promulgate regulations consistent with
VA, and WA (for QHPs)) have established requirements the ACA market reforms.
for the establishment of an internal claims appeals process
consistent with the ACA. Summary of State Adoption of ACA 2014 Market Reforms:

External review: Individual mandate:


 Forty-four states (AR, AZ, CA, CO, CT, DE, HI, ID, IL,  No state has established an individual mandate requirement
IA, IN, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, for the purchase of insurance since the enactment of the
MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, ACA. MA has an individual mandate requirement that was
RI, SC, SD, TN, TX, UT, VT, VA, WA, WV and WY) and enacted in 2006.
DC met parallel or similar requirements promulgated by
federal rules with respect to external review, so their Guarantee issue:
existing state processes continue to apply.  CT2 and MN3 enacted guarantee issue (GI) requirements
 Six states (AL, AK, FL, GA, PA, and WI) follow a federal post-ACA.
HHS administered independent external review process.

Other Approaches:
Many states (e.g., AL, AR, CO, CT, FL, GA, IL, KY, LA, MN, 2 PA 15-247/SB 1023, adopted/effective 7/10/15.
MO, MT, NE, NH, NJ, NM, ND, SC, TX, and WI) and DC 3Minnesota Statutes 2012 §62A.65; Adopted 2013
have also issued bulletins or guidance requiring health
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 Six states (ME, MA, NJ, NY, VT, and WV) have  NY and VT impose community rating which
requirements for GI of all individual health insurance prohibits the use of age rating.
products; but all were enacted pre-ACA.  MA imposes a 2:1 age rating band.
 Four states (MI, PA, RI, and VA) plus DC have GI
requirements that apply only to the insurer of last resort. Allowing rate band of 1.5:1 for individuals who smoke:
 VT and VA laws will expire upon the 2014 ACA  Forty-five states plus DC allow variation in rating based on
implementation deadline. tobacco use in the individual market. However, ten states
(CT, LA, ME, MT, NV, NC, OR, SD, UT and VA) have
Prohibitions on pre-existing condition exclusions: established (post-ACA) specific provisions allowing a rate
 State laws vary widely (generally ranging from six months band of 1.5:1 for individuals who smoke.
to one year) with respect to the time period under which a  NJ, RI, and VT have no provisions.
preexisting condition exclusion can be imposed for adults
over 19 years of age. Requiring the designation of an EHB:
 After the enactment of the ACA, eleven states (AK, AZ, The ACA requires health insurance issuers offering health
CA, HI, MD, MN, NC, OR, UT, WA, and WI) enacted insurance coverage in the individual or small group markets to
prohibitions on the use of pre-existing condition provide coverage for the “essential health benefits” (EHB)
exclusions/limitations. package effective January 1, 2014. These requirements apply to
qualified health plans (QHPs) in the Exchange as well as
Limiting the age band to 3:1: outside the Exchange. To the extent a state does not make its
 CA, CO, DC, LA, ME, NV, NH, SD, UT and VA own EHB designation, CMS makes the selection for the state.
established provisions limiting the age band to 3:1 in the All states have an EHB selected.
individual market post-ACA.  Eleven states (CA, CO, CT, ID, MD, MA, MN, NY, RI,
 ME’s law transitioned up to a 5:1 age band in VT, and WA) and DC have state based exchanges – all
20154. designate their own EHB.
 MA, NY, and VT all have requirements enacted pre-ACA  Three states (AL, KS, and PA) participate in the federally
that are more restrictive than the 3:1 age band imposed by facilitated marketplace (FFM) and appear to select the
the ACA. EHB.
 Twenty-five states (AK, AZ, FL, GA, HI, IN, LA, ME,
MS, MO, MT, NE, NJ, NC, ND, OH, OK, SC, SD, TN,
4ME Rev. Stat. Ann. Tit. 24-A, §4309 and ME Rev. Stat. Ann. Tit. 24A §2736-
TX, UT, VA, WI, and WY) participate in the FFM and
C(2)(D); Adopted 2012 appear to allow CMS to select the EHB.
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 Seven states (DE, IL, KY, MI, NV, NM, OR) participate in
a state-based marketplace using a federal platform and
appear to select the EHB.
 Two states (AR and IA) participate in a state-based
marketplace using a federal platform and appear to defer
the EHB selection to CMS.
 Two states (NH and WV) participate in a state-based
partnership; NH appearing to select the EHB itself, and
CMS selecting the EHB in WV.

Chart: The following chart notes states that have established


statutory or regulatory requirements consistent with the ACA
for the specified 2010 and 2014 reforms noted above. It also
includes bulletins addressing these reforms, but not those
providing information or guidance for filing policy forms to
comply with the ACA requirements. It also does not capture
states that may have established requirements on the identified
provisions prior to the adoption of the ACA.

5
State Adoption of ACA 2010 and 2014 Market Reforms

2010 Market ACA Reforms

Rescissions (19 states plus DC)


Alaska (Bulletin 13-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
California (Cal. Hth. & S. Code §1389.21 & Cal. Ins. Code §10384.17; Adopted 2010)
Colorado (Revised Bulletin B-4.34;Issued 2010)
Connecticut (Public Act 11-58/SB 6308; Adopted 2011)
Delaware (Del. Code Ann. tit. 18 § 3558; Adopted 2010)
District of Columbia (B 792; Adopted 2011)
Hawaii (Haw. Rev. Stat. §§ 431:10A-105.5 & 105.6, §§ 432:1-107 & 107.5, and §§ 432D-28 & 29; Adopted 2011/2014)
Kansas (Kan. Stat. Ann. §40-2209(d)(1)2)(B); Adopted 2011)
Louisiana (LA Rev. Stat. Ann. §22:1068, §22:1074, and §22:1063; Adopted 2010)
Maine (ME Rev. Stat. Ann. Tit. 24-A, §4309-A; Adopted 2011)
Maryland (MD Code Ann. Ins. §15–137.1; Adopted 2011)
Minnesota (Minnesota Statutes 2012 §62Q.186; Adopted 2013)
New York (NY Ins. §3015;Adopted 2011)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
Oregon (OR Rev. Stat. §§ 743B.013 & 743B.310; Adopted 2011; OR Admin. R. §§ 836-053-0825 & 0830 & 0835; Amended 2016)
South Dakota (SD Codified Laws §58-17-15; Adopted 2011)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code §38.2-3441; Adopted 2011)

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Dependent Coverage to Age 26 (27 states plus DC)
Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
California (Cal. Ins. Code § 10277; Cal. Hth. & S. Code §1373; Adopted 2010)
Colorado (Colo. Rev. Stat. § 10-16-104.3; Adopted 2013 )
Connecticut (Conn. Gen. Stat. §38a-554; Adopted 2009)
Delaware (Del. Code Ann. tit.18 §§3354 and 3570; Adopted 2011)
District of Columbia (D.C. Stat. §31-3271; Adopted 2010)
Hawaii (Haw. Rev. Stat. §431:10A-105.5, §432:1-107, and §432D-28; Adopted 2011)
Indiana (Ind. Code §§27-8-5-2 and 27-8-5-28; Adopted 2011)
Kentucky (Advisory Opinion 2010-4; Issued 2010)
Louisiana (LA Rev. Stat. Ann. §22:1000; Adopted 2010)
Maine5 (ME Rev. Stat. Ann. Tit. 24-A, §4320-B and §4309-A; Adopted 2011)
Maryland6 (Bulletin 2010-14, 2010-17, and 2010-28; Issued 2010)
Michigan (Emergency Rule 5; Issued 2010)
Minnesota (Minnesota Statutes 2012 §62A.302; Adopted 2013)
Montana (Mont. Code Ann. §2-18-704; Adopted 2011)
Nevada (NRS 689A.030 and NRS 689C.055; Amended 2013)
New Hampshire (NH Rev. Stat. Ann. §§243:8;243:9; and 243:11;Adopted 2011)
New York (NY Ins. §3216; Adopted 2011)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
North Dakota (ND Admin. Code §45-06-07-04; Bulletin 2011-3; Issued 2011)
Oregon (OR Rev. S. § 743A.090; Amended 2011)
South Dakota (SD Admin. R. §20:06:55:01, §20:06:55:02, §20:06:55:05, and §20:06:55:10; Issued 2010; S.D. Codified Laws §§58-17-2.3 and 58-18-
31.1; Adopted 2011)
Utah (Utah Code Ann. §§ 31A-2-212(5) & 31A-22-610.5; Adopted 2010/2011)
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code Ann. §33.2-3439; Adopted 2011)
Washington (Wash. Rev. Code §§48.20.435, 48.21.157, 48.44.215, and 48.46.325; Adopted 2012)
Wisconsin (Bulletin 9-3-2010; Issued 2010)

5Maine’s blanket ACA 2010 market reform compliance for dependent coverage was amended with specific statute referring to age 26.
6Maryland enacts specific dependent to age 26 provisions similar to the ACA. However, the department also issued bulletins with respect to templates for coverage of
children to age 26 to assist carriers with compliance with the ACA.
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No Annual Limits for Essential Benefits (16 states)
Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
Colorado (Revised Bulletin B-4.34; Issued 2010)
Connecticut (Public Act 11-58/SB 6308; Adopted 2011)
Hawaii (Haw. Rev. Stat. §431:10A-105.5, §432:1-107, and §432D-28; Adopted 2011)
Maine7 (ME Rev. Stat. Ann. Tit. 24-A, §4309-A and §4320; Adopted 2011)
Maryland (MD Code Ann. Ins. §15–137.1; Adopted 2011)
Minnesota (Minnesota Statutes 2012 §62Q.677; Adopted 2013)
New York (NY Ins. §3217-f;Adopted 2011)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
Oregon (OR Rev. Stat. §§ 743B.013; 743B.105; & 743B.125; Adopted 2011)
South Dakota (SD Admin. R. §20:06:55:15;Adopted 2010)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code §38.2-3440; Adopted 2011)
Washington (Guidance for Qualified Health Plans; Issued 2011)
Wisconsin (Bulletin 9-3-2010 and Bulletin 5-3-2010; Issued 2010)
No Lifetime Limits for Essential Benefits (16 states)
Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
Colorado (Revised Bulletin B-4.34; Issued 2010)
Connecticut (Public Act 11-58/SB 6308; Adopted 2011)
Hawaii (Haw. Rev. Stat. §431:10A-105.5, §432:1-107, and §432D-28; Adopted 2011)
Maine8 (ME Rev. Stat. Ann. Tit. 24-A, §4309-A and §4320; Adopted 2011)
Maryland (Bulletin 2010-23; Issued 2010; Md Code Ann. Ins. §15–137.1; Adopted 2011)
Minnesota (Minnesota Statutes 2012 §62Q.677; Adopted 2013)
New York (NY Ins. §§3217-f; Adopted 2011)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
Oregon (OR Rev. Stat. §§ 743B.013; 743B.105; & 743B.125; Adopted 2011)
South Dakota (SD Admin. R. §20:06:55:15;Adopted 2010)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)

7 Maine’s blanket ACA 2010 market reform compliance was amended with specific statute referring to annual limits.
8 Maine’s blanket ACA 2010 market reform compliance was amended with specific statute referring to lifetime limits.
8
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code §38.2-3440 ; Adopted 2011)
Washington (Guidance for Qualified Health Plans; Issued 2011)
Wisconsin (Bulletin 9-3-2010 and Bulletin 5-3-2010; Issued 2010)
Choice of Primary Care Provider (15 states)
Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
Colorado (Colo. Rev. Stat. §2013)
Connecticut (Public Act 11-58/SB 6308; Adopted 2011)
Hawaii (Haw. Rev. Stat. §431:10A-105.5, §432:1-107, and §432D-28; Adopted 2011)
Maine9 (ME Rev. Stat. Ann. Tit. 24-A, §4309-A and §4306; Adopted 2011)
Maryland (MD Code Ann. Ins. §15–137.1; Adopted 2011)
Minnesota (Minnesota Statutes 2012 §62Q.57; Adopted 2013)
New York (NY Ins. §3217-e; Adopted 2011)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
South Dakota (SD Admin. R. §20:06:55:15;Adopted 2010)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code §38.2-3443; Adopted 2011)
Washington (Guidance for Qualified Health Plans; Issued 2011)
Access to Obstetrical and Gynecological Services (16 states)
Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
Colorado (Colo. Regs. 4-2-16; Adopted 2012)
Connecticut (Public Act 11-58/SB 6308; Adopted 2011)
Hawaii (Haw. Rev. Stat. §431:10A, §432:1-107, §432D-28, and §432D-28; Adopted 2011)
Maine10 (ME Rev. Stat. Ann. Tit. 24-A, §4309-A and §4306-A; Adopted 2011)
Maryland (MD Code Ann. Ins. §15–137.1; Adopted 2011)
Minnesota (Minnesota Statutes 2012 §62Q.52; Adopted 2013)
New York (NY Ins. §3217-c; Adopted 2011)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
Oregon (OR Rev. Stat. § 743B.222; Adopted 2011)
South Dakota (SD Admin. R. §20:06:55:15;Adopted 2010)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)

9 Maine’s blanket ACA 2010 market reform compliance was amended with specific statute referring to primary care providers.
10 Maine’s blanket ACA 2010 market reform compliance was amended with specific statute referring to OBGYN services.
9
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code §38.2-3407.11; Adopted 2011)
Washington (Guidance for Qualified Health Plans; Issued 2011)

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Access to Pediatric Services (15 states)
Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
Colorado (Colo. Rev. Stat. 10-16-104.3; Adopted 2013)
Connecticut (Public Act 11-58/SB 6308; Adopted 2011)
Hawaii (Haw. Rev. Stat. §431:10A-105.5, §432:1-107, and §432D-28; Adopted 2011)
Maine (ME Rev. Stat. Ann. Tit. 24-A, §4309-A; Adopted 2011)
Maryland (MD Code Ann. Ins. §15–137.1; Adopted 2011)
Minnesota (Minnesota Statutes 2012 §62Q.57; Adopted 2013)
New York (NY Ins. §3217-e;Adopted 2011)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
South Dakota (SD Admin. R. §20:06:55:15;Adopted 2010)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code §38.2-3442; Enacted 2011)
Washington (Guidance for Qualified Health Plans; Issued 2011)
Preventive Services without Cost Sharing (18 states)
Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
California (Cal. Health & Safety Code §1367.002 and Cal. Ins. Code §10112.2; Amended 2011)
Colorado (Colo. Rev. Stat. §10-16-104.18; Adopted 2013)
Connecticut (Public Act 11-58/SB 6308; Adopted 2011)
Delaware (Del. Code Ann. tit. 18 § 3558; Adopted 2011)
Hawaii (Haw. Rev. Stat. §431:10A-105.5, §432:1-107, and §432D-28; Adopted 2011)
Maine11 (ME Rev. Stat. Ann. Tit. 24-A, §4309-A and §4320-A; Adopted 2011)
Maryland (MD Code Ann. Ins. §15–137.1; Adopted 2011)
Minnesota (Minnesota Statutes 2012 §62Q.46; Adopted 2013)
New York (NY Ins. §3216; Adopted 2011)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
Oregon (OR Rev. Stat. §743B.120; Adopted 2011)
South Dakota (SD Admin. R. §20:06:54:01; Adopted 2010)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code §38.2-3442; Enacted 2011)

11 Maine’s blanket ACA 2010 market reform compliance was amended with specific statute referring to preventive services without cost sharing.
11
Washington (Guidance for Qualified Health Plans; Issued 2011)
Internal Claim Appeals (24 states)
Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
Colorado (Colo. Rev. Stat. §10-16-113; Adopted 2013)
Connecticut (Public Act 11-58/SB 6308; Adopted 2011)
Delaware (Bulletin 44; Issued 2011)
Hawaii (Haw. Rev. Stat. §432E-5 Amended 2012; §431:10A-105.5, §432:1-107, and §432D-28; Adopted 2011)
Florida (Informational memorandum OIR-10-16; Issued 2010))
Louisiana (LA Rev. Stat. Ann. §22:2401 Adopted 2013)
Maine (ME Rev. Stat. Ann. Tit. 24-A, §4309-A; Adopted 2011)
Maryland (MD Code Ann. Ins. §15–137.1; Adopted 2011)
Minnesota (Minnesota Statutes 2012 §62Q.70; Adopted 2013)
Montana (MCA §33-32-301 – 309; Adopted 2015)
Nevada (Nev. Rev. Stat. 689A.745 & 689B.0285; Amended 2011 and Bulletin 11-013; Issued 2011)
New Jersey (NJ Admin. Code §§ 11:24A-1.2 & 3.2 – 3.7; Issued 2012)
North Carolina (N.C. Rev. Stat. § 58-3-300; Adopted 2013)
New York (NY Ins. §3216; Adopted 2011)
North Dakota (ND Cent. Code §26.1-36; Adopted 2011)
Oregon (OR Rev. Stat. §743B.250; Adopted 2011; OR Admin. R 836-053-1030; Issued 2012)
South Dakota (SD Admin. R. §20:06:53; Adopted 2010)
Utah (Utah Code Ann. §§ 31A-2-212(5) & 31A-22-629; Adopted 2011/2012) ; Utah Admin. Code §R590-203; Amended 2011)
Vermont (VT Stat. Ann. Tit. 8; §4062c; Adopted 2010)
Virginia (VA Code §§ 38.2-3556 to 38.2-3571; Enacted 2011)
Washington (Guidance for Qualified Health Plans; Issued 2011; Wash. Rev. Code § 48.43.530; Adopted 2012 Wash. Admin. Code §§ 284-43-3110 -
3150;Adopted 2015)
Wyoming (Wyo. Stat. Ann. § 26-40-201; Amended 2015)
External Review (44 states plus DC)
Arizona (Ariz. Rev. Stat. §§20.2537 to 20.2539; and §20-2531; Adopted 1997/2000; Amended 2013)
Arkansas (Ark. Code Ann. §23-61-108; Ar. Adm. Code 054 00 076; Adopted 2001)
California (Cal. Health & Safety Code §1370.4and §1345; Adopted 1999/2001; Cal. Health & Safety Code §§1374.30 to 1374.36; Cal. Ins. Code
§§10169 to 10169.5; Adopted 2001/2003/2012; Cal. Code Regs. Tit. 28, §§1300.70.4, 1300.74.30, 1368.01, and 1368.02; Issued 2002/2005)
Colorado (Colo. Rev. Stat. §10-16-113 and §10-16-113.5 3; Colo. Regs. §702-4, Reg. 4-2-21; Adopted and issued 2000/2011)
Connecticut (Conn. Gen. Stat. §38a-478n and §38a-478n-3; Adopted 1997/2011)
Delaware (Del. Code Ann. tit. 18 §§6416, to 6418; Del. Regulations 1301 and 1403;Adopted and issued 1998/2007)
District of Columbia (46 DC Code Ann. §§44-301.01 to 44-301.10; Adopted 1998)
Hawaii (Haw. Rev. Stat. §432E-31 – 44 Adopted 2011; Haw. Rev. Stat. §431:10A-105.5; §432:1-107, and §432D-28,; Adopted 2011)
12
Idaho (Idaho Code §41-5901, et. seq.; Adopted 2009/2011)
Illinois (215 Ill. Comp. Stat. 180/1; Ill. Admin. Code tit. 50 §5430.10 through §5430.80; Adopted and issued 2010)
Indiana (Ind. Code §§27-13-10.1-1 to 27-13-10.1-12; Adopted 2000/ 2011)
Iowa (Iowa Code §§514J.1 to 514J.15 ; Adopted 2000; Iowa Admin. Code §§191-76.1 to 191-76.9; Issued 2011)
Kansas (Kan. Stat. Ann. §§40-22a13 to 40-22a16; Adopted 2000)
Kentucky (KY Rev. Stat. Ann. §§304-17A-621 to 304-17A-631; Adopted 2000; 806 KY Admin. Regs. 17:290 ; Issued 2001/2003)
Louisiana (LA Rev. Stat. Ann. §22:2431; Adopted 2013)
Maine (ME. Rev. Stat. Ann. Tit. 24-A §4312 ; Adopted 2000/2011)
Maryland (MD Code Ann. Ins. §§15-10A-01 to 15-10A-09; MD. Regs. Code tit. §§31.10.18.01 to 10.18.15; Adopted 1999/2011)
Massachusetts (Mass. Gen. Laws Ch. 176O §§1, 12, 13 and 14; Adopted 2000; Mass. Regs. Code tit. 105, §128.400; Adopted 2001/2005)
Michigan (Mich. Comp. Laws §§550.190; 550.1911;550.1913; and 550.1919 ; Adopted 2000)
Minnesota (Minn. Stat. §62Q.73; Adopted 2013)
Mississippi (19 Miss. Admin. Code, Part 3, Chapter 15; Mississippi Health Carrier External Review Regulation, Adopted 2012)
Missouri (Mo Rev. Stat. §§376.1382 and 376.1387; MO Code Regs. Ann. tit. 20, §100-5.020 ; Adopted/issued 1997)
Montana (MCA §33-32-401 – 423; Adopted 2015)
Nebraska (NE Rev. Stat. §§ 44-7306, 44-7308, 44-7310, and 44-7311; Adopted 2013)
Nevada (Nev. Rev. Stat. §683A.3715 – 373; §§695G.241 – 310; ; Adopted 2011; Bulletin 11-013; Issued 2011)
New Hampshire (NH Rev. Stat. Ann. §§420-J:5a to 420-J:5e ; NH Code Ann. R. §§2703.01 to 2703.09; Adopted/issued 2000/2005)
New Jersey (NJ Stat. Ann. §26:2S-12; NJ Admin. Code §§ 8:38- 8.7 to 8:38-8.8;Adopted 1997/2006)
New Mexico (NM Stat. Ann. §59A-57-4.1; Adopted 1998; NM Admin. Code Tit. 13, §10:13.15; Issued 2001)
New York (NY Ins. §§4910 through 4916; NY Comp. Codes R. & Regs. tit. §§410.1 to 410.13 and §98-2.5; Adopted/ issued 1999 and 2011)
North Carolina (NC Gen. Stat. §58-50-61; §§58-50-75 to 58-50-95 and §58-50-61(a)(13) and §58-3-300; Adopted 1997/2009/2013)
North Dakota (ND Cent. Code §26.1-36-44; Adopted 2005/2011)
Ohio (Ohio Rev. Code Ann. §17.1751.85 and §1751.01; Adopted 1997/2000; Ohio Rev. Code Ann. §§17.1751.84 and 17.3901.81; Issued 2000)
Oklahoma (Okla. Stat. tit. 36, §§ 6475; Adopted 2000)
Oregon (Or. Rev. Stat. §§743B.252 – 258; Or Admin. R. 836-053-1300 – 1365; Adopted and issued 2001/2011)
Rhode Island (RI Gen. Laws §23-17.12-10; Adopted 1992; RI Code R. §23-1.12-007; Issued 2005)
South Carolina (SC Code Ann. §§38.71.1910 to 38.71.2060; Adopted 2000) (SC Bulletin 2011-04; Issued 2011)
South Dakota (SD Admin. R. §20:06:53; Adopted 2010)
Tennessee (Tenn. Code Ann. §§56-61-101 – 56-61-125; Adopted 2011)
Texas (Tex. Code Ann. §21. 58A and §21.58C ; 28 Tex. Admin. Code Part I Chap. 12; Adopted and issued 1997/2011)
Utah (Utah Code Ann. §§ 31A-2-212(5) & 31A-22-629; Adopted 2011/2012)
Vermont (VT Stat. Ann. tit. 8 §4089a; Vt. Code R. §21-020-045; Bulletin HCA-104; Adopted 1994/2002; VT Stat. Ann. tit.8, §4089(f) ;Vt. Code R.
§21- 040-012; Adopted/issued 1999/2005)
Virginia (VA Code §§38.2.3556 to 38.2.3571;Adopted 2011)
Washington (Wash Rev. Code §48.43.535; Adopted 2011Wash. Admin. Code §284-43-3210; Adopted 2015)
West Virginia (W. Va. Code §33-25C-, §33-16H1 and W.VA Code St. R. §§114-58-1 to 114-58-13)

13
Wyoming (Wyo. Stat. Ann. §, 26-40-201; Amended 2015)

2014 Market ACA Reforms

Prohibitions on Preexisting Condition Limitations (11 states)


Alaska (Bulletin 2013-09; Issued 2013)
Arizona (Ariz. Rev. Stat. §§20-238; Adopted 2013)
California (Cal. Health & Safety Code §§ 1357.51 & 1357.52 and Cal. Ins. Code §§ 10198.7 & 10198.9; Adopted 2012)
Hawaii (Haw. Rev. Stat. §431:2-201.5; Amended 2013)
Maryland (MD Code, Insurance, §15-137.1;Adopted 2012)
Minnesota (Minnesota Statutes 2012 §62A.65; Adopted 2013)
North Carolina (NC Rev. Stat. § 58-3-300; Adopted 2013)
Oregon (OR Rev. Stat. § 743B.003 & 743B.011 & 743B.013 & 743B.105; Adopted 1011/2012)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)
Washington (Wash Rev. Code §§ 48.43.012 & 48.43.015; Amended 2011)
Wisconsin (Bulletin 9-3-2010 and Bulletin 5-3-2010; Issued 2010)
3:1 Age Band Limits (8 states plus DC)
California12 (Cal. Health & S. Code §§ 1357.512 & 1399.855 and Cal. Ins. Code §§ 10753.14 & 10965.9; Adopted 2012/2013)
Colorado (3 CCR 702-4 Emergency Regulation 13-E-02; Adopted 2013 and Regulation 4-2-39; Adopted 2013)
District of Columbia (DC Code Ann. §31-3311.02; Adopted 2012)
Louisiana (LA Rev. Stat. Ann. §22:106; Adopted 2014)
Nevada (NRS 687B.500; Adopted 2013)
New Hampshire13 (NH Rev. Stat. Ann. § 420-G:4, I(d); Adopted 2013)
South Dakota (SD Admin R. 20:06:22:27; Adopted 2013)
Utah14 (Utah Code Ann. §31A-2-212(5); Adopted 2011)
Virginia (VA Code Ann. §38.2-3447; Adopted 2013)
1.5:1 Limit on Tobacco Use15 (7 states)
Louisiana (LA Rev. Stat. Ann. §22:106; Adopted 2014)
Maine (ME Rev. Stat. Ann. Tit. 24A §2736-C(2)(D);Adopted 2012)
Nevada (NRS 687B.500; Adopted 2013)
New Hampshire16 (NH Rev. Stat. Ann. § 420-G:4, I(d); Adopted 2013)

12 Adopts provisions by reference to rating requirements of the ACA.


13 Adopts provisions by reference to rating requirements of the ACA.
14 Adopts provisions by reference to rating requirements of the ACA.
15 Forty-five states plus DC allow variation in rating based on tobacco use in the individual market. However, LA, ME, NV, NH, SD, UT, and VA have established

specific provisions allowing a rate band of 1.5:1 for individuals who smoke.
14
South Dakota (SD Admin R. 20:06:22:27; Adopted 2013)
Utah (Utah Code Ann. §31A-2-212(5); Adopted 2011)
Virginia (VA Code Ann. §38.2-3447; Adopted 2013)

16 Adopts provisions by reference to rating requirements of the ACA.


15