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New Jersey – 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 New Jersey is doing to protect you from unfair and unnecessary premium rate increases. Here’s a summary of the New Jersey laws that govern rate increases.

  • New Jersey does not have prior approval authority to approve or deny individual market rate increases before they go into effect.
  • Rates are filed with the Department of Banking and Insurance on a file-and-use basis, i.e., rates may be implemented “upon” submission of the rate filing supporting the increase. NJSA § 17B:27A-9(d).
  • Rates may be disapproved if the filing is incomplete, if they do not comply with state laws governing individual health benefit plans, or if they are inadequate or unfairly discriminatory. NJSA § 17B:27A-9(d).
  • Rates must be formulated to meet an 80% medical loss ratio. Rebates or credits will be required annually to the extent that actual loss ratios do not equal 80%. NJSA § 17B:27A-9(d).
  • Individuals must receive 30 days notice of a rate change.

Rate filings are not available online, but monthly rates are available at http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates.htm.

IssuesHealth