Individual Market Rate Restrictions - Kaiser State Health Facts

Individual Market Rate Restrictions (Not Applicable to HIPAA Eligible Individuals), 2008

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	Limits on Rating?	Types of Rating Restrictions?	Noteable Exceptions

United States	NA	NA

Alabama	No	No
Alaska	No	No
Arizona	No	No
Arkansas	No	No
California	No	No	Premiums for the standardized policy, the policy that insurers and HMOs must guarantee issue to those exhausting high risk pool coverage, are restricted at 110% of the standard rate.
Colorado	No	No
Connecticut	No	No
Delaware	No	No
District of Columbia	No	No
Florida	No	No
Georgia	No	No
Hawaii	No	No
Idaho	Yes	Rate Bands	Premiums for standardized policies, or "High Risk Pool" policies, are capped at 2.5 times the standard rate for underwritten individual market policies.
Illinois	No	No
Indiana	No	No
Iowa	Yes	Rate Bands
Kansas	No	No
Kentucky	Yes	Rate Bands
Louisiana	Yes	Rate Bands
Maine	Yes	Adjusted Community Rating
Maryland	No	No
Massachusetts	Yes	Adjusted Community Rating
Michigan	No	No
Minnesota	Yes	Rate Bands
Mississippi	No	No
Missouri	No	No
Montana	No	No
Nebraska	No	No
Nevada	Yes	Rate Bands
New Hampshire	Yes	Rate Bands
New Jersey	Yes	Pure Community Rating	Premiums for Basic and Essential plans are adjusted for age, gender and geography
New Mexico	Yes	Rate Bands
New York	Yes	Pure Community Rating
North Carolina	No	No
North Dakota	Yes	Rate Bands
Ohio	No	No	Premiums for guaranteed issued policies are capped at 2.5 times the standard rate for underwritten individual market policies.
Oklahoma	No	No	HMOs are required community rate
Oregon	Yes	Adjusted Community Rating
Pennsylvania	No	No
Rhode Island	No	No
South Carolina	No	No
South Dakota	Yes	Rate Bands
Tennessee	No	No
Texas	No	No
Utah	Yes	Rate Bands
Vermont	Yes	Adjusted Community Rating
Virginia	No	No
Washington	Yes	Adjusted Community Rating
West Virginia	No	No
Wisconsin	No	No
Wyoming	No	No

(show/hide notes)

Notes:	This chart is not applicable to HIPAA eligible individuals. For rules that apply to HIPAA eligible individuals refer to HIPAA Rules.
Sources:	Data as of December 2008. Data compiled through review of state laws and regulations and interviews with state health insurance regulatory staff. Data collection and analysis by researchers at the Health Policy Institute, Georgetown University. Special Data Request, February 2009.
Definitions:	Rate Rules: In many states, premiums for individual health insurance vary based on health status. A few states impose rating restrictions and prohibit rating based on health status in the individual market. In some states, pure community rating is required, so premiums also cannot vary by age or gender. Adjusted community rating means premiums can be adjusted for age or other factors. Other states impose health status rate bands which limit the amount by which premiums can vary due to health status.

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