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Iowa – Health Insurance Premium Rate Review Laws

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

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

  •  Iowa has prior approval authority to approve or deny rate increases before they go into effect.  Iowa Code § 514A.13.
  • A rate increase is deemed approved unless disapproved within 30 days of filing.  Iowa Code § 514A.13
  • Rate increases for accident and health insurance may be disapproved if “benefits provided are unreasonable in relation to the premium charged.”  Iowa Code § 514A.14.  
  • Rates for HMOs “shall not be excessive, inadequate, or unfairly discriminatory.”  Iowa Code § 514B.10.
  • Insurers must “immediately” notify policyholders of any application for a rate increase that exceeds the average annual health spending growth rate stated in the most recent national health expenditure projection published by the Centers for Medicare and Medicaid Services.  Iowa Code § 505.19.
  • Public hearings must be held for all rate increases exceeding the average annual health spending growth rate stated in the most recent national health expenditure projection published by the Centers for Medicare and Medicaid Services.  Iowa Code § 505.19
  • The Consumer Advocate of the Insurance Division shall solicit public comment on such rate increases and post comments on its website.  Iowa Code § 505.19
  • The hearing process and notice of hearing requirements are set out in regulations. Iowa Admin. Code 191-36.20.  The hearing is not considered a contested case under Iowa Code chapter 17, and rules of evidence need not be observed.  Iowa Admin. Code 191-36.20(6).
  • The Commissioner and the Consumer Advocate of the Insurance Division must file an annual report to the governor and general assembly about “health spending costs for health insurance plans,” including rate increases, surplus, loss ratios, and cost drivers.  Iowa Code § 505.18.
  • Rate filings are considered public records, unless an insurer request confidentiality for certain information and the Commissioner elects to keep the information confidential.  Iowa Code § 505.17.
  • Rate increases since 2005 are available at http://www.iid.state.ia.us/about_us/ProductReg/LifeHealth/docs/1_Rate%20Increase%20Report_split%20by%20year.pdf.
IssuesHealth