Health Insurance Rate Review
Each year, the Minnesota Commerce Department reviews the proposed individual and small group health plans submitted by insurers. These are plans that insurers intend to offer to consumers during the annual open enrollment period which begins on November 1. Rates must be approved by the Commerce Department prior to the plans being sold to consumers.
Small group health plans are designed for small employers with 2-50 workers. Individual health plans are designed for Minnesotans who do not receive coverage from employer-based insurance or public programs such as Medicare, Medicaid and MinnesotaCare. Instead, they obtain coverage from individual health plans that they purchase directly through MNsure, insurance brokers/agents or the insurance companies themselves.
The Commerce Department does not “set” health insurance rates. Instead, it reviews the information submitted by the insurers to determine whether their proposed rates are justified. Rates must be justified both by the benefits that consumers receive for their premiums and by the insurance company’s ability to pay expected medical claims costs based on premium revenue.
Rate review also ensures that policies comply with state and federal laws that protect consumers – including coverage of pre-existing conditions and free preventive care, the adequacy of the provider network, and the procedures an individual must go through in order to enroll or have a claim paid.
In addition, the Affordable Care Act limits the factors that insurers can use to charge individual consumers higher health insurance rates. For coverage effective January 1, 2014, rates can vary based only on age, tobacco use, family size and geography.
Commerce may deny or modify proposed rates (up or down) if it determines that they are excessive or inadequate in relationship to the benefits offered.
According to Minnesota state law, Minnesota Statute 60A.08, subd. 15, insurers’ proposed rates are nonpublic data until they are approved and effective. The purpose of this law is to allow companies to file their rates without revealing trade secret information and to ensure a fair and competitive marketplace during the rate review process.
However, the federal RateReview.HealthCare.gov website does make publicly available a summary of the rate increases proposed by Minnesota insurers, as well as a summary of the insurers’ justification for these rate increases.
As part of the Commerce Department’s rate review process, Minnesotans may submit public comments on proposed rate increases by e-mail to email@example.com.
Approved and Effective Rates
Information--including the summary of benefits and coverage, plans and benefits, rates, and service area for plans offered on and off MNsure in the individual and small group market--are available by health insurance company.