|
|
|
| Home > Insurance Division > Life and Health > Life and Health Actuarial > Rate Review |
| Health Insurance Education: Rate Review Process and Consumer Resources |
The Rate Information & Oversight (RIO) program was established within the New Jersey Department of Banking and Insurance (DOBI) to allow for transparent coordination of consumer information with regard to rates, which are sometimes referred to as premiums.
This program allows actuarial staff to:
- Create and distribute educational material for consumers;
- Respond to inquiries from consumers about rates for various forms of health insurance, including comparison of rates;
- Monitor public comments on rates and rate filings;
- Respond to rate complaints; and
- Monitor the quality of information filed by the carriers.
|
| If you have any questions or comments on the information provided here, please send your e-mail to: RateReviewComments@dobi.state.nj.us. |
Note: E-mails sent to this address will generate an automated response. This e-mail address is for consumers to provide FEEDBACK and COMMENTS only on proposed or actual rate increases for Individual Health Care (IHC) or Small Employer Health Benefits (SEH) insurance policies.
COMPLAINTS AND INQUIRIES are handled through a separate unit. If you are filing a COMPLAINT, or have an INQUIRY, about any type of insurance, including Long Term Care, you must use the Insurance Complaints / Inquiries process. |
|
|
|
| The Rate Review Process: |
Under NJ State law, DOBI has the authority to review and disapprove rate filings that are found to be incomplete or not in substantial compliance with the law.
DOBI’s rate review process determines if the rate increase is unreasonable if, for example:
- It is based on faulty assumptions or unsubstantiated medical trends.
- It charges different prices to people who pose similar risks.
- It does not meet Minimum Loss Ratio (MLR) standards.
- It does not comply with permissible rating factors.
The federal government has determined that NJ’s rate review process is effective. While DOBI reviews all individual and small employer requests for rate increases, any insurance company that wishes to raise rates by 10% or more (on an annualized basis) must explain the reasons for the increase to the federal government. These explanations – called justifications – are being posted on the Federal web site at www.HealthCare.gov (See Insurance Company Rate Increases below)
Note: The Federal Rate Review rules apply to new plans in the individual and small employer markets. If your health plan was already in effect on March 23, 2010, it may be a grandfathered plan, which is exempt from the Federal Rate Review rules, including the posting of rate increase of 10% or more on the Federal web site. Your carrier can tell you whether or not your plan is grandfathered. DOBI continues to review all requests for rate increases, even those for grandfathered plans.
For more specific information on the DOBI rate review process, please click on any of the FAQ links below. |
| |
| Additional Information: |
The Individual Health Coverage (IHC) Program was created to ensure that people without access to employer or government sponsored health care programs could purchase health coverage for themselves and their families from a variety of private carriers.
The Small Employer Health Benefits (SEH) Program became operational in 1994 to ensure small employers: (1) have access to small group health benefits plans without regard to the occupation of the group, or the health status of any of the group's members; and (2) have the ability to renew the coverage from year to year regardless of the group's claims experience or any changes in the health status of the group's members. |
| |
|
|
| |
Data |
Frequently Asked Questions |
| |
|
|
|
| |
| Additional Resources: |
| IHC Cost-Sharing and Benefits Grid |
This grid was designed to help consumers understand the various components of their individual health coverage policy. The first page has definitions and examples of the cost-sharing options for each plan offered for sale through the IHC as well as the relevant dollar amounts. The second and third pages, although not all-inclusive, list the benefits and indicate whether or not the benefit is covered under each of the plan options. Please note that the cost-sharing options and the benefits are regulated by the IHC Board. The carriers may choose which of the cost-sharing options to include but the benefits – covered or not covered – are standard for all plans.
|
|
| Consumer Assistance |
Information and resources about other NJ programs may be found at:
|
|
| Insurance Company Rate Increases |
Effective September 1, 2011, the Federal Rate Review Program holds insurers accountable for rate increases. Two of the program’s features are: Rate Review and Medical Loss Ratio Standards (MLR). To meet the MLR standards, insurers must spend between 80% and 85% of the premium dollars on health care costs or activities. If they don't, they must provide refunds to policy holders.
Rate increases of 10% and higher are being posted, along with their justifications, on the Federal web site at:
|
|
| Options for Health Insurance |
Small employers may qualify for Federal tax credits that make it more affordable to provide health insurance to their employees. Further information is available at:
Individuals may find details on the types of health insurance plans best suited to their needs and the associated costs at: |
| |
|
| Rutgers Center for State Health Policy (CSHP) |
CSHP has published a number of studies on the Affordable Care Act (ACA) and other relevant health issues which can be found on their web site: http://www.cshp.rutgers.edu/
CSHP is an initiative of the Institute for Health, Health Care Policy and Aging Research (IHHCPAR) to create a formal capacity within Rutgers, the State University of New Jersey, for policy analysis, research, training, facilitation, and consultation on state health policy. CSHP combines Rutgers University's traditional academic strengths in public health, health services research, and social science with applied research and policy analysis initiatives. It serves as the focal point within the University for research and related activities relevant to state health policy. |
|
|
| FAIR Health |
FAIR Health is a national corporation whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive consumer resources. The web site offers educational articles and videos about the healthcare insurance reimbursement system on topics such as
- Understanding Your Explanation of Benefits (EOB)
- "Plain speak" to help consumers
better understand the healthcare system;
- “Reimbursement 101” to help navigate the twists and turns of healthcare reimbursement; and
- A glossary of common health terms intended to help educate consumers
|
|
|
| |
| |
| |
| Carrier Rate Filing Information: |
|
|
