Health Insurance Rate Review Process

Rate Review Approval Process

All health insurance rates are subject to review in Vermont.  Filings are reviewed by a Department Rate Analyst, the Director of Rates and Forms, and an Actuarial Consultant. 

Filings for any rate request related to comprehensive major medical plans are also reviewed by the Health Care Ombudsman and the Green Mountain Care Board (GMC Board).  The process is detailed below.  

Factors Considered During a Review:

  • the company’s past rate activity
  • administrative costs
  • actual dollars spent on medical care (claims data)
  • current trends in the insurance market
  • the number of people affected by the changes (policyholders)
  • Consumer comments for increase requests over 5%
  • Medical Loss Ratio (MLR): Insurance carriers are required to spend at least 80% of the money collected from insurance premiums on health care services or quality improvements.  See the links below for more information.
     

End Result:

The reviewer’s job is to make sure the rate increase is “affordable, promotes quality care, promotes access to health care, and is not unjust, unfair, inequitable, misleading, or contrary to the laws of this state.” 

Learn more about the health insurance market in Vermont, the terminology used as well frequently asked questions about health insurance:

http://www.dfr.vermont.gov/sites/default/files/FAQ2010IssueBrief-healthinsurance.pdf

Related Links:

If you have questions or technical difficulties please contact:

Sean Londergan at (802)828-2917   or
Phil Keller at (802)828-1464