For Consumers

Health insurance rate frequently asked questions

About our health insurance rate-request search

How can I understand why my company wants to change my rate?

Anytime a health insurer requests a rate change, it must back up its request with data. We create a summary for each request to help you understand why your company believes it needs a rate change. Each one-page summary includes:

  • The average percentage change the company is requesting.
  • When the new rate would take effect.
  • How many people are impacted.
  • Key information the company used to develop the rate.
  • How it plans to spend your premium.
  • If there are any benefit changes.
  • The company's annual rate request history.

To see a summary for any rate request, go to the health rate search site, find the company name, and look under "Request details."

The data in the summaries is supplied by the company. Part of our rate review includes double-checking and verifying the company's information. If we disagree with the company's data, we may disapprove the rate.

Once you make a decision, where can I learn more?

Once we've reviewed the rate request and made our final decision, we write a decision memo. The memo outlines:

  • Our reasons behind the decision.
  • What we consider in our review.
  • Key information the company used to develop its request.
  • If we disagreed with the company, why and about what.
  • If the rate change includes any benefit changes.

To see a decision memo for any rate request, go the health rate search site, find the company name, and look under "Request details."

Can I be notified when my company wants to change my rate?

Yes. You can sign up to get an email whenever your health insurer wants to change your rate. Once you've signed up and selected your company, we'll send you an email notification whenever:

  • Your health plan requests a rate change.
  • The request is withdrawn.
  • The request is revised.
  • We've made our decision.

How we review rates

What types of health plans do you regulate?

We review the rates and policies of all individual and small employer (employers with 1-50 employees) health plans. We also review the policies for large employer health plans (51+ employees), but most employers can negotiate the rates with their insurance company.

Some large employers self insure -- this means they pay for their employees' health coverage and may use an insurance company only to administer the plan. We do not review those rates.

What do you consider when reviewing a rate request?

A company's requested rate must be reasonable in relation to the benefit it provides. If the information the company files doesn't support this, then we can either ask for more information, approve a lesser rate or reject an increase.

How we review rate requests.

What's impacting rates

I rarely go to the doctor - why do my premiums keep going up?

Individual and small employer health insurance rates are community rated. This means that insurers look at the claim experience of everyone in either the individual or small group market. That's why your premium could change even if you haven't filed a claim.

Here are the other factors that determine how much you pay in monthly premiums:

Individual plan (plans you buy yourself): Your age, where you live, how many family members are covered, whether you or your family members smoke and which benefits you choose.

Small group plan (plans for employers with 1- 50 employees): The employees' age, where they live, their family size, and the benefits they choose.

How much of my premium goes to executives' salaries?

Executive and CEO salaries are part of the health plans' administrative costs. They grab a lot of headlines, but actually make up a tiny portion of your rate. In general, the amount of premium going to CEO salaries is less than $1 per member per month.

To see specific information about your company, take a look at the summary and decision memo associated with its rate request. The summary includes the percentage of your premium going to administrative costs and the decision memo tells you the amount in dollars.