Open enrollment is the specific time of the year that individuals and families can buy or change their private health insurance coverage without a qualifying life event such as the birth of a child.
The next open enrollment period for health insurance plan in the individual market will begin on November 1, 2016, and continues through January 31, 2017. If you receive health insurance through your workplace, your employer will inform you about its open enrollment period.
Except for special enrollment periods (or SEPs) that are triggered by qualifying life events, new plans that will be effective on and after January 1, 2017, will become available during the open enrollment period that begins on November 1, 2016, and continues through January 31, 2017.
Consumers will need to sign up by the December 16, 2016, for coverage starting January 1, 2017.
If you sign up between December 16, 2016, and January 15, 2017, your coverage will start February 1, 2017. If you sign up between January 16 and January 31, 2017, your coverage will start March 1, 2017.
Once open enrollment ends, it will be harder to get coverage. Except for special enrollment periods that are triggered by qualifying life events, health insurance carriers are not required to accept people applying for individual policies year-round. Individuals cannot wait until they get sick to buy coverage because they might not be able to find it when that happens.
There are some opportunities to buy coverage outside of the open enrollment period. These are called “special enrollment periods” (or SEPs). SEPs occur after a “qualifying life event,” which include getting married or divorced, having a new baby, losing coverage through a job, or moving to a new state. If one of these events happens, individuals and families will have a certain amount of time afterward to buy new coverage or change health plans (usually 30 days).
Minnesotans who are eligible for public programs such as MinnesotaCare or Medical Assistance, who own a small business with 50 or fewer employees, or who are enrolled members of a federally-recognized Indian tribe can enroll year-round for health coverage through MNsure.
Health insurance rates are reviewed by the experts in the actuarial unit at the Minnesota Department of Commerce. The Commerce Department also reviews the rates submitted by Health Maintenance Organizations (HMOs) under an interagency agreement with the Minnesota Department of Health.
Health insurance companies need to submit rate filings for new plans and if they are requesting change in rates for an existing plan.
All health insurance rates must be approved by the Minnesota Department of Commerce or the Minnesota Department of Health prior to becoming effective, as required in Minnesota. Statute 62A.02.
The terms “rate” and “premium” are often used interchangeably when discussing insurance. However, those terms represent two different things.
Individual and small group health insurance rates are determined for a particular plan of benefits from a particular network of doctors and hospitals based on the combined medical costs of everyone in that company’s market for a particular age, tobacco use, and geographic area. This is called community rating– the rates are based on the costs of the entire community (geographic area).
The rising cost of medical care affects rates. With community rating, your premium may go up even if you haven’t received any medical services, if the average cost of services has increased.
In general, how much a health plan company charges depends on the following:
Health plan companies develop rates using estimates of future claim costs, administrative expenses, and how much in reserves they need to hold.
Claim costs: The amount a company expects to pay for health care services and goods, such as physician services, hospital fees, and prescription drugs, on behalf of all policyholders with similar policies.
Administrative expenses: The cost of running a health plan. These costs can include:
Contribution to reserves: Money that the insurance company has left after paying for claims and administrative expenses. The reserves are needed to pay for claims and administrative expenses in years when the plans do not collect enough premiums to cover those costs.
All health plan rate filings must meet these criteria:
In order to demonstrate that the above criteria are met, the filing must include at least the following information:
Approved- If the filing is clear and justifies the filed rates, the filing is approved and the health plan company is notified that the rates may be used.
Objection- If the information in the filing is not clear or does not justify the filed rates or rate increase, the Department of Commerce sends an objection letter to the filing company.
No. A decision is made for each filing as to whether the rate is approved or not approved.
The health plan company can request a hearing, and have a judge decide whether the Department's decision not to approve a filing was reasonable or unreasonable.
If you buy your own health insurance or have coverage through your employer, your premium may change each year because you have:
In addition, if you have coverage through your employer, your premium may change due to:
If your rate increased, and you buy your own health insurance, check with your insurance carrier to find out the exact cause. If you have coverage through your employer, your human resources benefits office may be able to provide this information.
Your premium will not go up solely because you have claims, just as it will not go down solely because you do not have claims. Insurance is a pooling of risks, so individuals pay a share of the pooled experience in exchange for not assuming the full risk of their own medical costs. If you have an individual or small employer policy, your premium is based on the claims of everyone with your type of policy. If you have coverage under a large employer health plan, your premium is based in part on the claims of everyone in the group.
Minnesotans are encouraged to submit comments about health insurance rates by emailing email@example.com
You can contact the Department of Commerce Consumer Services Center by e-mail at firstname.lastname@example.org or by phone at 651-539-1600 (local) or 800-657-3602 (Greater Minnesota only).