{"data":{"id":"us/45-cfr-154.102","jurisdiction":"us","citation":"45 CFR 154.102","heading":"Definitions.","body":"As used in this part:\nCMS means the Centers for Medicare \u0026 Medicaid Services.\nEffective Rate Review Program means a State program that CMS has determined meets the requirements set forth in § 154.301(a) and (b) for the relevant market segment in the State.\nFederal medical loss ratio standard means the applicable medical loss ratio standard for the State and market segment involved, determined under subpart B of 45 CFR part 158.\nHealth insurance coverage has the meaning given the term in section 2791(b)(1) of the PHS Act.\nHealth insurance issuer has the meaning given the term in section 2791(b)(2) of the PHS Act.\nIndividual market has the meaning given the term in § 144.103 of this subchapter.\nPlan has the meaning given the term in § 144.103 of this subchapter.\nProduct means a package of health insurance coverage benefits with a discrete set of rating and pricing methodologies offered in a State. The term product includes any product that is discontinued and newly filed within a 12-month period when the changes to the product meet the standards of § 147.106(e)(2) or (3) of this subchapter (relating to uniform modification of coverage).\nRate increase means, with respect to rates filed—\n(1) For coverage effective prior to January 1, 2017, any increase of the rates for a specific product offered in the individual or small group market.\n(2) For coverage effective on or after January 1, 2017, any increase of the rates for a specific product or plan within a product offered in the individual or small group market.\nRate increase subject to review means a rate increase that meets the criteria set forth in § 154.200.\nSecretary means the Secretary of the Department of Health and Human Services.\nSmall group market has the meaning given the term in § 144.103 of this subchapter.\nState means each of the 50 States and the District of Columbia.\nUnreasonable rate increase means:\n(1) When CMS is conducting the review required by this part, a rate increase that CMS determines under § 154.205 is:\n(i) An excessive rate increase;\n(ii) An unjustified rate increase; or\n(iii) An unfairly discriminatory rate increase.\n(2) When CMS adopts the determination of a State that has an Effective Rate Review Program, a rate increase that the State determines is excessive, unjustified, unfairly discriminatory, or otherwise unreasonable as provided under applicable State law.","path":["Title 45—Public Welfare","SUBTITLE A—Department of Health and Human Services","SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS","PART 154—HEALTH INSURANCE ISSUER RATE INCREASES: DISCLOSURE AND REVIEW REQUIREMENTS","Subpart A—General Provisions"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-45.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:21Z","sha256":"a5c505af691de3f8b783c10f0aa25cbff24ee828f8d0baf1a274f078cce050df","source_id":"us-cfr","stale":true,"prev":"us/45-cfr-154.101","next":"us/45-cfr-154.103"},"notice":"GroundRules: Original legal text. Not legal advice."}