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Health Insurance Premiums

Health insurance premiums are the monthly amount you or your employer pay to an insurance company.  The insurance company collects premiums from all of its policyholders and uses that money to pay for their medical claims.  The insurance company can also use premiums to pay for its administrative expenses and to earn profit. 

Premium Rate Increases and Prior Approval

The Prior Approval law requires health insurers make an application to the Department of Financial Services to evaluate their proposed rate changes. The Department reviews the rate applications along with the insurer’s underlying calculations to make sure that any premium rate increases are justified and not excessive. During its review, the Department may request more information from the insurer and consider comments from policyholders or the public (see "Consumer Notification" below). Rate applications and all documents relating to an application can be found here:

Submit a comment about an insurer’s proposed rate increase

DFS has set up a website to allow policyholders to submit comments about an insurer’s proposed premium rate increase. Insurers must also send their customers a notice about a proposed premium rate increase when they file the application with DFS. This notice should state that an application has been filed and that you can review the application on the DFS website and submit comments about the premium increase.

The insurance company is also required to send policyholders a second, more specific notice if a final premium rate has been approved. This notice will contain more specific information about your particular premiums.

Insurers' Justifications for Proposed Rate Increases

Health insurers must file a copy of a plain-English summary of the reasons why they are requesting a premium rate increase. This summary is called the "preliminary justification" and must be filed for all (non-Grandfathered) individual and small group rate applications.  The preliminary justification is intended to provide consumers with a summary and a breakdown of how premiums are spent.

Insurers are also required to post their final justification on their own websites. DFS provides access to this document, via our Rate Applications by Company (portal) application when you search for a particular company.

Requested Increase vs. Approved Increase

DFS provides summaries of requested premium rate increases and approved rate increases, sorted by year, by market segment (individual or small group) and by company.

Frequently Asked Questions

See some of the most frequently asked questions about Prior Approval and health insurance rate increases.

Updated 09/05/2014

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