Arizona – Health Insurance Premium Rate Review Law

If you buy health insurance on the individual market, without help from an employer, you may want to know what Arizona is doing to protect you from unfair and unnecessary premium rate increases.  Here’s a summary of the Arizona laws that govern rate increases.

  • Arizona does not have prior approval of premium rate increases for individual market products.
  • Insurers must file rates and rate increases for individual PPO and indemnity products with the Department of Insurance for review; however, rates and rate filings are not required for HMOs.
  • The state Department of Insurance currently reviews filings only to determine that they are complete.
  • Rates are required to result in benefits that are reasonable in relation to premiums, i.e., medical loss ratio minimums are met (between 50% and 60%). ARIZ. ADMIN. CODE § R20-6-607.
  • Rates and rate filings are not publicly available on state agency websites but are considered public documents available for inspection upon request.

Information is based on review of state statutes and regulations and, in some cases, interviews with state insurance departments.

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