Community Rating - Occurrence

Occurrence

Community rating of supplemental private health insurance:

• Australia — lifetime community rating of private hospital insurance supplemental to universal publicly financed hospital insurance
• Ireland — pure community rating of all private health insurance supplemental to universal publicly financed health insurance

Community rating of basic private health insurance:

• Netherlands — age and gender rating illegal = pure community rating; individual guaranteed issue
  • individual mandate with low-income government subsidies for 40% of households
• Switzerland — age and gender rating illegal = pure community rating; individual guaranteed issue
  • individual mandate with low-income government subsidies for 40% of households
• within the United States:
  • Community rating for individual and small group (2 to 50 employees) health insurance:
    • New York — age and gender rating illegal = pure community rating; individual guaranteed issue
    • Vermont — age and gender rating illegal = pure community rating for small group health insurance; individual guaranteed issue
      • age and gender rating illegal = pure community rating for individual health insurance from BlueCross BlueShield and HMOs
      • age and gender rating combined limited to 1.5:1 (150 percent) for individual health insurance from other insurance companies
    • Maine — age rating limited to 1.5:1 (150 percent); gender rating illegal; individual guaranteed issue
      • smoking status rating unlimited
    • Massachusetts — age rating limited to 2:1 (200 percent); gender rating illegal; individual guaranteed issue
      • individual and employer mandates with low-income government subsidies or exemptions
    • New Jersey — age and gender rating combined limited to 3.5:1 (350 percent); individual guaranteed issue
    • Washington — age rating limited to 3.75:1 (375 percent); gender rating illegal
    • Oregon — age rating unlimited ; gender rating illegal
  • Community rating for small group (2 to 50 employees) health insurance only:
    • Maryland — age rating limited to 2.8:1 (280 percent); gender rating illegal
    • New Hampshire — age rating limited to 4:1 (400 percent); gender rating illegal
    • Rhode Island* — age and gender rating combined limited to 4:1 (400 percent)
      • *health status rating limited to ± 10% of community rating
    • Colorado — age rating unlimited; gender rating illegal
    • Connecticut — age and gender rating unlimited
  • No community rating, but age rating limited and/or gender rating illegal and/or health status rating limited:
    • Age rating limited in individual health insurance: to 3:1 (300 percent) in Minnesota, to 4:1 (400 percent) in New Hampshire, to 5:1 (500 percent) in North Dakota and South Dakota
    • Age rating limited in small group health insurance: to 3:1 (300 percent) in Minnesota and South Dakota
    • Gender rating illegal in individual health insurance in: Minnesota, Montana, North Dakota
      • Gender rating limited to 1.2:1 (120 percent) in New Mexico
    • Gender rating illegal in small group health insurance in: California, Iowa, Michigan, Minnesota, Montana, North Dakota
    • Health status rating limited (but no guaranteed issue) of individual health insurance:
      • Iowa — health status rating limited to 1.35:1 (135 percent)
      • New Hampshire — health status rating limited to 1.5:1 (150 percent)
      • Minnesota — health status rating limited to 1.67:1 (167 percent)
      • Nevada — health status rating limited to 1.75:1 (175 percent)
      • South Dakota — health status rating limited to 1.86:1 (186 percent)
      • Utah — health status rating limited to 1.86:1 (186 percent)
      • Louisiana — health status rating limited to 2:1 (200 percent)
      • Kentucky — health status rating limited to 2.08:1 (208 percent)
      • Idaho — health status rating limited to 3:1 (300 percent)