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The Health Insurance Rate Review Process

Application

Nevada law requires prior approval by the Division of Insurance of any rate change for individual and small group health insurers. Insurers are required to submit any proposed rate changes to the Insurance Division for evaluation.

Your Voice

You may submit comments to us regarding the proposed rate changes. Your comments may be posted to the web publicly or you can mark them as private and for our internal reference only. Your comments will be considering during the rate review process.

Division’s Review

Division of Insurance staff and an independent actuarial firm review the rate change applications to ensure that any proposed rate change is warranted.
The following factors are considered in determining the justification of the proposed rate:

  • Past claims experience, which reflects the cost of medical care and prescription drugs.
  • “Utilization”, which is how often the policyholders use medical services and prescription drugs, and how the insurer “trends” that claims experience and utilization into the future.
  • The insurer’s history of rate changes, its financial condition, administrative costs, profits, other sources of revenue and any other factors the insurer uses to justify its proposed premium rate change.
  • Your public comments.

During our review, we may request more information from the insurer. An application is not complete until all information required has been submitted.
Your comments will be considered as we review rate change applications.

Division’s Decision

We have 30 days from the date the rate change application is complete, to approve, modify or disapprove an insurer’s rate change application.
We may modify or reject rates that we deem excessive, inadequate or unfairly discriminatory. We may also consider the insurer’s financial condition in making that decision.

Final Notice to Policyholders

Insurers must give at least 60 days advance notice of the approved premium rate change to policyholders.

Definitions

"rate" is the base price for health benefits for a specific product. When an insurer changes their base rates, the final premium is affected by the amount of change.

The “premium” is the actual amount paid by a policyholder for a specific product. The premium is determined by applying rating factors to the rate.  The ACA only allows four rating factors to be applied to the base rates: age, where you live, family composition and tobacco use.

Using our rate comparison tool you can get an estimate of your actual cost or premium.