Individual and small group health plans are those that insurers intend to offer consumers during the annual open enrollment period, which begins Nov. 1. Small group health plans are for employers with 2-50 workers. Individual health plans are for Minnesotans who purchase their own coverage rather than receiving it through employer-based insurance or public programs such as Medicare, Medical Assistance and MinnesotaCare.
All proposed rates are available in System for Electronic Rate and From Filings (SERFF, available through Minnesota’s SERFF Filing Access). Follow these step-by-step instructions to access the rates:
Approve: If the filing is complete, clear and justifies the filed rates, the filing is approved and the health plan company is notified that the rates may be used.
Object: If the information in the filing is incomplete, not clear, or does not justify the filed rates or rate increase, the Department of Commerce sends an objection letter to the filing company.
The filing company must respond accordingly within the time period provided in the objection. If no response is received, the filing may be closed without approval.
The objection/response process is often iterative.
When the filing is found to be complete, clear, and justifies the rates, the filing is approved and the health plan company is notified that the rates may be used.
Disapprove: If Commerce determines the filing does not justify the filed rates, the filing is disapproved and the filing company is notified that the rates may not be used.
Upon notice of disapproval, a hearing will be granted if a written request is received from the filing company within 20 days.
All individual and small group health plan rate filings must meet these criteria:
Projected loss ratio meets state and federal minimum requirements
Rates are sufficient to cover expected claims and expenses
Rates provide a reasonable value to the insured
The filing is complete, correct, understandable, and justified
To demonstrate that the above criteria are met, the filing must include:
Historical experience including premiums, claims, enrollment, and durational/seasonal patterns
Statistical reliability of historical experience
The reasons for a proposed rate increase or decrease, such as anticipated changes in: cost and utilization of health care services, benefits covered, market demographics, taxes, and/or fees.
