If you buy health insurance on the individual market, without help from an employer, you may want to know what Delaware is doing to protect you from unfair and unnecessary premium rate increases. Here’s a summary of the Delaware laws that govern rate increases.
- Delaware has prior approval authority for individual market products. Ins. Code § 2506.
- Regulators have 30 days to approve or disapprove the rates; they are deemed approved if regulators do not respond with the 30-day period. Ins. Code § 2506.
- Rates may not be disapproved unless they are inadequate, excessive or unfairly discriminatory. Ins. Code §§ 2501, 2503; De. Admin Code 18-1305(6.3).
- Benefits are deemed reasonable in relation to premiums if state medical loss ratio minimums are met (50%-65%, based on coverage type). De. Admin Code 18-1305(8.0).
- As an alternative to prior approval review, an insurer may use rates upon filing if the insurer makes a lifetime and yearly medical loss ratio guarantee that rates meet or exceed the minimums, backed up by an actuarial memorandum and “detailed experience information” and description of process used to develop loss ratio and supporting data. De. Admin Code 18-1305(9.0).
- Rate filings are not posted online, but the Department of Insurance website has a list of increases requested and approved.