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pdf CPIC House Insurance & Banking 01.12.11
1/6/2011 © Health News Florida
By Carol Gentry

Most policies for individuals and small groups in Florida had double-digit rate increases last year, according to a study released today. That level would be considered unreasonable under a proposed federal rule.

The double-digit increases were reviewed and approved by the Florida Office of Insurance Regulation.

Of the 28 approvals, according to an analysis by consumer group Florida CHAIN, only three were below 10 percent -- not counting added cost for deductibles or co-pays.

The proposed rule, which is to take effect July 1 if approved, requires more scrutiny and publicity for rate hikes that exceed 10 percent in the individual and small-group market (the large-group market is not affected). The idea was part of the new health law, the Patient Protection and Affordable Care Act, but setting the percentage was left to health officials to determine by the rule-making process.

If it is approved, rate increases over 10 percent could still go through, but companies would have to justify them and post them on the Internet.

The CHAIN analysis of last year's rate hikes for individual and small-group plans that consisted of at least 1,000 members showed two with rate hikes of more than 20 percent: a Humana plan with more than 49,000 members went up 21.8 percent; and an American General plan with around 1,600 customers, 25 percent.

The three plans that had rate hikes under 10 percent were sponsored by Colonial Life, Florida Health Care Plan, and Central United Life.

A press release from CHAIN and several other consumer groups sent out this morning said that most of the pending rate increases for the coming plan year also exceed 10 percent. The average certificate-holder, it said, will face an increase of 12.8 percent.

Double-digit rate hikes for individual and small-group plans are in fact the norm in Florida. OIR officials have explained to Health News Florida in the past that their main job is making sure rates are actuarily sound so that companies can pay claims and not go under,  leaving customers with big bills and no coverage.

Plans that have members who are unconnected to  one another -- individuals, families, or workers in small firms -- tend to have higher rate hikes than those comprised of large employers' workers and families, for a number of reasons. One is that large groups have more clout in deal-making; another is that insurers keep forming new groups for individuals and small firms, and these new group plans have initial low rates that attract healthy people. That leaves less-healthy members who can't jump ship paying  premiums that go up and up in a process called the "death spiral."

The differences in rates between large-group and small-group plans could even out after 2014, when companies will no longer be able to deny coverage to those who have health problems. The new law has so far extended that protection only to children.

--Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.