Viva Health Blog

DID YOU KNOW THAT INSURANCE COMPANIES FILE THEIR RATES WITH THE STATE?

Well, most do. With the exception of Alabama, Louisiana, Oklahoma, Texas, Missouri, and Wyoming all states are required to have effective review programs to review insurance premium increases over a certain percentage. Even states without a rate review program are required to submit insurance rate increases that increase 10% from the previous year for federal review.

Purportedly (http://www.ncsl.org/research/health/health-insurance-rate-approval-disapproval.aspx), these reviews should be available on healthcare.gov. However, no such filings can be found on the site – likely because no insurance company has increased their rates 10%

So where does that leave consumers curious about rate increases and how those increased are accounted for?

For those curious about how much premiums have risen, there isn’t much recourse. In 2010 BC/BS of Alabama released some data detailing the amount the Affordable Care Act taxes affected insurance holders’ premiums. Since then, no data is available beyond an individual’s own statements.

However, there is the 80/20 rule. The 80/20 rule stipulates that 80% of a company’s premium must be spent on medical claims and improving patient insurance holders’ quality of care, as opposed to being spent on advertising or overhead. This gives policy holders at least some information on how health insurance companies spend their premiums.

It should be noted that companies that don’t meet the 80/20 rules are obligated to pay insurance policy holders rebates from their premiums. To see if your company meets the 80/20 rule, you can look here: https://data.healthcare.gov/browse?category=MLR&utf8=%E2%9C%93.

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Last updated 10/1/2019


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