Who regulates health insurance companies?

Health insurance companies are regulated by state and federal governments. At the federal level, the Centers for Medicare & Medicaid Services (CMS) has the primary responsibility of overseeing health insurance companies, including enforcing the Affordable Care Act (ACA), which sets standards for health insurance coverage. The CMS also issues regulations and guidance on health insurance products and plans, and it has the authority to take enforcement actions against health insurance companies that violate the law or regulations.

At the state level, health insurance companies are also regulated by state insurance departments or commissions. These state agencies have the authority to approve health insurance policies and plans, set rates, and enforce state laws and regulations governing health insurance. State insurance departments also play a role in consumer protection, investigating and resolving complaints from policyholders about their health insurance companies.

In addition to federal and state regulations, health insurance companies may also be subject to voluntary accreditation standards developed by organizations such as the National Committee for Quality Assurance (NCQA). NCQA accredits health insurance companies based on standards for quality, performance, and customer service.