The Health Insurance Rate Review Process

Application

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

Your Voice

You may submit comments to us regarding 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 considered during the rate review process.

Division’s Review

Division of Insurance staff and outside actuarial firms review the rate change applications to ensure that any proposed rate change is warranted.

The following factors are considered in determining whether a proposed rate is justified:

• Past claims experience, which reflects the cost of medical care and prescription drugs.
• “Utilization”, which is how often policyholders use medical services and prescription drugs.
• 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 determine to be excessive, inadequate or unfairly discriminatory. We may also consider the insurer’s financial condition in making that decision.

Final Notice to Policyholders

Insurers in the small group market must give at least 60 days advance notice of the approved premium rate change to policyholders.  Insurers in the individual market are required to give notice in writing 30 days before the beginning of open enrollment for the upcoming year.  The specific requirements of the statute are available here in NRS 687B.420.

Definitions

A "rate" is the base price for health benefits for a specific plan. When an insurer changes its 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 plan. 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 the actual cost of your plan.