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New York law limits insurance rate increases

by Heather Mayer, DOTmed News Reporter | June 11, 2010
New York insurance reforms
mirror federal policy
As part of New York Gov. David Paterson's health insurance reform agenda, the governor signed into law this week the Governor's Program Bill No. 278, which reinstates the New York State Insurance Department's authority to review and approve health insurance premium increases before they take effect. The law passed in a 111-17 vote.

Prior to the new law, New York regulated health insurance premiums under a "file and use" law, which limited the state's ability to disapprove health insurance premium increases and essentially allowed the insurance industry to self-regulate.

"Deregulation of health insurance premiums is a failed experiment leading to unjustified premium increases and more people losing their health insurance coverage," Paterson said in prepared remarks.

The law requires health insurers and HMOs to apply for approval from the state's insurance department in order to increase premiums.

"Before, health insurance companies could raise premiums as much as they wanted, and all we could do is check long afterward if, in fact, they were overcharging," David Neustadt, spokesman for the New York State Insurance Department, told DOTmed News. "The current rates are increasing at a much faster rate than before [the file and use law]."

The structure of the newly signed law is to ensure that any premium increase is "justified and not excessive," according to the governor's office. The insurance department has the authority to approve, modify or reject the application. The law applies to rate increases that will take effect on or after Oct. 1, 2011.

This move goes hand-in-hand with the federal Patient Protection and Affordable Care Act, which requires health insurers to report justifications for "unreasonable" rate increases, in addition to percentage of premiums spent on claims, quality of care, taxes and administrative costs.

"I applaud New York on its bold move to hold insurance companies accountable and prevent the kind of unreasonable rate increases that have made health insurance unaffordable for many American families," said U.S. Health and Human Services Secretary Kathleen Sebelius in a statement. "This is the kind of action that, together with the Affordable Care Act, is shifting power back to consumers."

Effective immediately, the legislation also requires insurers and HMOs to spend more of each premium dollar on medical claims. The medical loss ratio -- the percentage of premiums spent to provide medical care -- increases from 75 percent to 82 percent for small businesses covered and from 80 percent to 82 percent for individuals.