The rules presented in this chart are only applicable small-group employer plans. Rules that apply to individuals are available at Individual Market Guaranteed Issue

Data as of January 2009. Data compiled through review of federal and state law and interviews with government regulators.
Data collection and analysis by researchers at the Health Policy Institute, Georgetown University.

Rate Rules: In many states insurers are permitted to vary premiums for small group health insurance on, among other factors, the health status of the small employer group. A few states impose rating restrictions and prohibit rating based on health status. In some states, pure community rating is required, so premiums also cannot vary based on health status or any other factor. Adjusted community rating means premiums can not vary based on health status but may be adjusted based on other factors. Other states impose health status rate bands which limit the amount by which premiums can vary due to health status. Rating bands vary substantially across states; in some states, small group premiums could be surcharged by more than 100 percent for health status.

1. Rate bands apply only to groups sized 2-25.
2. Rate bands apply only to groups sized 3-35.
3. BCBS (non-profit hospital corporations and non-profit professional health service plans) and HMOs are permitted to set premiums using an adjusted community rating.
4. BCBS and HMOs are permitted to set premiums using rate bands.
5. Rating restrictions apply only to groups sized 3-25.
6. Insurers are permitted to set premiums for standardized policies using rate bands.