Pennsylvania Insurance Department Press Secretary, Ronald Ruman, announced on October 9th that as a result of the PACE Act, the size of a “small group” for purposes of health insurance in Pennsylvania will remain at 50 or fewer. The definition of “small group” under Pennsylvania state law (Act 134 of 2011) incorporates the federal definition, and the state law would have required the definition to expand to 100 only in accordance with the federal trigger date. As the PACE Act retains the 50 employee limit in the federal definition, and removes the trigger date, the Pennsylvania Department of Insurance is not required to expand its definition of “small group” to 100 employees.

The Department has further announced that it will not accept adjustments to already approved rates for Q-1 2016. If the change in the definition of a small group market impacts the rate assumptions that insurers made in their 2016 filings, issuers may file quarterly rate changes for Q-2 and later in 2016 to reflect this change. The small group single risk pool must follow the state definition of small group market. Thus, all future small group rate filings should only include experience and projections for group policies covering employers with 50 or fewer employees.

Any questions should be directed to Cynthia Borrelli.


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