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Health Insurance Rating: How Much Does Health Insurance Cost?

October 25, 2007

Health Insurance policies cost and rating varies by state and by policy type. Individual policies are rated according to state guidelines overseen by each state’s Department of Insurance. Individuals have more challenges to get coverage than ever. Health insurers are able to exclude conditions or totally deny coverage to individuals with prohibitive risks. For this reason, individuals pursuing coverage should not cancel a group policy until they have received written confirmation that the individual policy is in-force.

Many states have high risk pools that allow individuals who might otherwise be unable to get coverage to do so via the high risk pool. In states where there is not high risk pool the situation is much more difficult to get coverage. Health insurance rating or underwriting will allow health insurers to deny coverage. Therefore, individuals with a serious health condition will be precluded from getting coverage and may have to turn to public open enrollment through a health insurer to obtain coverage. But this path is an expensive one. Public open enrollment policies can cost over a $1,000 per month for single coverage and $3,000 per month for family coverage.

Health insurance for employers is rated differently than individual policies. In accordance with the Health Insurance Portability and Accountability Act (HIPAA) and state laws, employers who contribute towards health coverage and have enough employees participate must be guaranteed coverage. These laws are for employers with between 2-50 employees. Pricing can vary however and an employer with no health conditions will be able to get cheaper coverage than an employer with a more serious list of health conditions.

The rating of health insurance is a complex situation with variances occurring by state and by the type of coverage one is seeking. If individuals or employers want to get more information on what is available in their state, they should visit the Department of Insurance website to begin their information quest. Typically these websites provide ample information to learn the basics of what the state laws entail. In addition, all insurers are generally listed with information about receiving coverage. Health insurance is a complex industry with differences between all 50 states.

HIPAA protects consumers when it comes to egregious rating practices by health insurers. If you have coverage and pursue another policy and are accepted, health insurers cannot impose a preexisting condition limitation as long as you have not had a 63 day gap in coverage. So don’t cancel your policy until you have proof of coverage from your new policy.

Author Description

Scott is a partner in ESP Benefit Design, an employee benefits insurance firm based in Westerville, Ohio. (614-882-8535) Scott has an MBA from Franklin University. Scott has worked with over 6,000 customers. Email Scott at scott@espbd.com

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