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SMALL GROUP HEALTH INSURANCE MARKET WORKING GROUP CHAPTER 370, LAWS 2010

SMALL GROUP HEALTH INSURANCE MARKET WORKING GROUP CHAPTER 370, LAWS 2010. Review of Legislative Charge. Implementation Options in Expanding the Small Group Definition to 100 Employees Underwriting Concerns and Rating Requirements Implications of Size Change on Entire Market

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SMALL GROUP HEALTH INSURANCE MARKET WORKING GROUP CHAPTER 370, LAWS 2010

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  1. SMALL GROUP HEALTH INSURANCE MARKET WORKING GROUP CHAPTER 370, LAWS 2010

  2. Review of Legislative Charge • Implementation Options in Expanding the Small Group Definition to 100 Employees • Underwriting Concerns and Rating Requirements • Implications of Size Change on Entire Market • Costs for Employers, Brokers and Health Plans • Migrating from Fully-Insured to Self-Insured • Uniform Application Form • Section 125 Plans • Impacts of Federal Law

  3. Small Employer Definition Current MN Small Employer Definition (62L.02, Subd. 26) Actively Engaged in Business Employed average of 2 -50 employees during prior year Employs at least 2 employees on the first day of the plan year. Small employer status determined annually on renewal.

  4. Small Employer - Guarantee Issue • Small Employer coverage guaranteed issue if the employer (62L.03) • Contributes at least 50% toward the cost of coverage, and • 75% of eligible employees who have not waived coverage participate on the plan.

  5. Small Employer Coverage • Restrictions Relating to Premium Rates (62L.08) • Total Adjustments limited to 25% above or below index rate for the following underwriting factors: • Health Status • Claims Experience • Industry of Employer • Duration of Coverage from Date of Issue • Additional adjustment allowed up to 50% above or below index rate based on Age

  6. Small Employer Coverage • Restrictions Relating to Premium Rates (62L.08) • Geographic variations permitted if each geographic region composed of no fewer than 7 counties • Gender based rating prohibited • Index Rates filed & approved by Department of Commerce

  7. Small Employer Coverage • Restrictions Relating to Premium Rates (62L.08) • Renewal Rates Limited to • % Change in Index Rate PLUS • Up to 15% adjustment due to claims experience, health status, and duration of coverage PLUS • Adjustment for change in coverage or change in case characteristics of the Employer

  8. Questions? Contact: John Gross Director of Health Care Policy Minnesota Department of Commerce 85 7th Place East, Suite 500 St. Paul, MN 55101-2198 Phone: 651-297-2319 E-Mail: john.gross@state.mn.us Web site: www.commerce.state.mn.us

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