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Texas-Rate Review Law

If you buy health insurance on the individual market, without help from an employer, you may want to know what Texas is doing to protect you from unfair and unnecessary premium rate increases.  Here’s a summary of the Texas laws that govern rate increases.  Caution: the laws and regulations on the books don’t always reflect what actually happens in practice.  Contact your state’s insurance agency for further information.

  • Texas does not have prior approval of rate increases for individual market products.
  • Insurers need only file rates and rate increases along with basic actuarial information with the state’s Department of Insurance. TEXAS ADMIN. CODE,  title 28, § 3.4.
  • If rate increases are 50% or more over a 12-month-period, the insurer must provide further justification. TEXAS ADMIN. CODE. title 28, § 3.4.
  • For individual HMO plans, insurers must file the formula or method used to calculate premiums with the Department of Insurance before rate increases go into effect. TEXAS INS. CODE § 1271.251. The companies’ actuary must certify that the method does not lead to rates that are excessive, inadequate, or unfairly discriminatory. TEX. ADMIN. CODE title 28, § 11.701.
  • Rates and rate increases are not publicly available on state agency websites; some rate filings may be obtained through Public Records Request, others may require a determination from the Attorney General if the insurer has requested confidentiality for the filing.

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