Rate Review Frequently Asked Questions

No, the Insurance Department rate authority is defined by law and is based on an actuarial review of rates based on claims expenses for a particular policy form. There is also authority to consider "administrative expenses" in determining whether a rate is reasonable.

Once you have a health insurance policy, make sure you understand how it works so that you do not pay more than you have to. For example, does your policy charge you more if you use non-contracted (out-of-network) hospitals, doctors, specialists, or other providers? Lead a healthy lifestyle. Take advantage of insurance company or community wellness programs that might reduce your premiums. To the extent possible, play an active role in managing your health care. Please contact your health insurance agent or health insurer directly to learn ways in which you may be able to lower your premiums. This applies to individual and small group policies.

In Mississippi, health insurers are required to notify all affected individuals or family policy holders sixty (60) days prior to the implementation date of any rate increase.

MID looks at a number of factors, including but not limited to: recent and future costs of medical care, the insurance company's history of rate changes, its financial strength, premiums, and administrative costs. We also consider the insurance company's overall profitability, investment income, surplus, and public comments. Insurers must show that the new rate is reasonable considering the benefits. If the insurance company's data does not fully support the increase, MID can ask for more information or disapprove the increase.

Health insurance companies must take in enough money to pay medical claims plus a reasonable amount for administration. In Mississippi in 2011, on average, approximately 81 cents of every premium dollar collected from individuals and small employer health plans paid for health care (medical claims). The remaining 19 cents paid for insurance company administrative costs, including collecting premiums, paying claims, and selling insurance.

There are a number of factors that contribute to the costs of health insurance. Part of the increase is due to inflation; how much more services cost one year versus the next. This goes up in large part based on contracts between insurance companies and doctors and hospitals, as well as charges for services such as laboratory tests and x-rays. Costs also go up when we use more health care or more expensive care. This is affected by everything from an aging population to poor health (diabetes and other chronic diseases) to changes in how doctors and hospitals treat certain conditions. Rate changes occur when existing premiums are no longer sufficient to cover projected claims and administrative costs for that policy.

Mississippi has a competitive health insurance market with many companies that sell individual, Medicare insurance coverage, and small group health plans. It is important to compare benefits and prices of various health insurance policies and choose the right plan for you. You can do this on your own by contacting different companies or you can get help from an insurance agent or broker.

MID reviews the rates of all types of individual and small group accident and health insurance plans, including accident and health insurance issued by health maintenance organizations (HMO) and non-profit medical and hospital services corporations, state of Mississippi and School Employees Health Insurance Plan, and certain single employer or union related plans.