The Regulation of the Individual Health Insurance Market. Appendix B

12/01/2008

National Association of Health Underwriters State Level Individual and Small Group Market Health Insurance Reforms March 2007

State Individual Market Reforms Small-Group Market Reforms[1]
Guarantee Issue Rating Structure Elimination Riders Preexisting Conditions
(Look-Back/Exclusionary Period in Months)
Credit for Prior Coverage Medically Uninsurable Individuals Size[2] Preexisting Conditions
(Look-Back/Exclusionary Period in Months)
Rating Structure
Alabama No NRS Yes 60/12 No HRP[3] 2-50 6/12 +/- 20%
Alaska No NRS Yes None No HRP 2-50 6/12 +/- 35%
Arizona HIPAA[4] NRS Yes[5] None[6] No[7] None 2-50 6/12 +/- 60%
Arkansas No NRS Yes 60-month Look-Back No HRP 2-50 6/12 +/- 25%
California HIPAA[8] NRS No 6/6 or 12/12[9] Yes HRP/GI[10] 2-50 6/6 +/- 10%
Colorado No NRS Yes 12/12 Yes HRP 1-50[11] 6/12 +/10%  -25%
Connecticut No NRS Yes 12/12 No HRP 1-50[12] 6/12 MCR[13]
Delaware HIPAA[14] NRS Yes[15] None[16] No[17] None 1-50[18] 6/12 +/- 35%
Florida HIPAA[19] NRS Yes[20] 24/24[21] Yes HRP[22] 1-50[23] 6/12 MCR +/- 15%[24]
Georgia HIPAA[25] NRS Yes[26] 24-month Exclusionary Period[27] No[28] None 2-50 6/12 +/- 25%
Hawaii HIPAA[29] NRS Yes[30] 36-month Exclusionary Period[31] No[32] None 1-50[33] None NRS[34]
Idaho GI[35] +/- 50% No 6/12[36] Yes HRRP 2-50 6/12 +/- 50%
Illinois No NRS Yes 12/24[37] No HRP 2-50 6/12 +/- 25%
Indiana No NRS No 12/24 No HRP 2-50 6/9 +/- 35%
Iowa No RB[38] Yes 12/12 and 60/12[39] No[40] HRP 2-50 6/12 +/- 25%
Kansas No NRS Yes 12/24 No HRP 2-50 6/3 +/- 25%
Kentucky No +/- 35% No 6/12 Yes HRP 2-50 6/12 +/- 35%
Louisiana No NRS[41] Yes 12/12 Yes HRP 3-35 6/12 +/- 35%
Maine GI[42] MCR[43] No 12/6 Yes GI 2-50 6/12 MCR[44]
Maryland No NRS Yes 4/24 No HRP 1-50[45] 0/0 MCR[46]
Massachusetts GI[47] MCR[48] No 6/6 Yes GI 1-50[49] 6/6 MCR[50]
Michigan GI[51] CR/NRS[52] No 6/6 and 6/12[53] No CLR[54] 2-50[55] 6/12 +/- 45%[56]
Minnesota No RB[57] No 0[58] Yes HRP 2-50 6/12 +/- 25%
Mississippi No NRS Yes 12/12 No HRP 1-50[59] 6/12 +/- 25%
Missouri No NRS Yes[60] Unlimited/24[61] No[62] HRP 3-25 6/12 +/- 25%
Montana No NRS Yes 36/12 Yes HRP 2-50 6/12 +/- 25%
Nebraska No NRS Yes None No HRP 2-50 6/12 +/- 25%
Nevada HIPAA[63] +/- 50% Yes[64] None[65] Yes None 2-50 6/12 +/- 25%
New Hampshire No RB Yes 3/9 Yes HRP 2-50 6/12 MCR[66]
New Jersey GI[67] CR[68] No 6/12 Yes GI 2-50 0/0 or 6/6[69] MCR[70]
New Mexico No NRS Yes 6/6 Yes HRP 2-50 6/6 +/- 25%
New York GI[71] MCR[72] No 6/12 Yes GI 2-50 6/12 CR[73]
North Carolina HIPAA[74] NRS Yes[75] 12/12[76] Yes CLR[77] 1-50[78] 6/12 +/- 20%
North Dakota No RB No 6/12 Yes HRP 2-25 6/12 +/- 35%
Ohio HIPAA[79] NRS[80] Yes 6/12 Yes OE[81] 2-50 6/12 +/- 35%
Oklahoma No NRS[82] Yes None[83] No HRP 2-50 6/12[84] +/- 25%
Oregon GI[85] MCR[86] Yes None[87] Yes HRP 2-25 6/12 MCR[88]
Pennsylvania HIPAA[89] NRS Yes[90] 60/36[91] No[92] CLR[93] 2-50[94] 6/12 NRS[95]
Rhode Island GI[96] NRS Yes[97] 36/12[98] No[99] CLR[100] 1-50[101] 6/12 +/- 10%
South Carolina No NRS Yes 12/12 and unlimited/24[102] No HRP 2-50 6/12 +/- 25%
South Dakota No +/- 30% Yes 12/12 Yes HRP 2-50 6/12 +/- 25%
Tennessee HIPAA[103] NRS Yes[104] None[105] No[106] None[107] 2-50 6/12 +/- 35%
Texas No NRS Yes 60/24[108] Yes[109] HRP 2-50 6/12 +/- 25%
Utah GI[110] +/- 30% Yes 6/12 No HRP 2-50 6/12 +/- 30%
Vermont GI[111] MCR[112] No 9/12 Yes GI 2-50 6/12 MCR[113]
Virginia HIPAA[114] NRS Yes[115] 12/12[116] No[117] CLR[118] 2-50 6/12 NRS[119]
Washington GI[120] MCR[121] No 6/12 Yes HRP 2-50 6/12 MCR[122]
West Virginia No +/- 30% Yes 12/24 No HRP 2-50 6/12 +/- 30%
Wisconsin No NRS Yes 24-month Exclusionary Period No HRP 2-50 6/12 +/- 30%
Wyoming No NRS Yes 6/12 Yes HRP 2-50 6/12 +/- 35%

Explanation of Abbreviations

Individual Market Reforms

Guarantee Issue—GI=Guarantee issue required; and HIPAA=People exercising their group-to-individual portability rights under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) must be guarantee-issued products in the traditional individual market.

Rating Structure—NRS=No rating structure. Medical underwriting allowed without restriction; RB=Rate bands; CR=Community rated; MCR=Modified community rated; and +/- X%=Rate bands of plus or minus the specified percentage of the indexed rate.

Medically Uninsurable Individuals—HRP=High-risk health insurance pool; HRRP=High-risk reinsurance pool; None=No mechanism for providing individual market access to medically uninsurable people; CLR=Carrier of last resort; OE=Open enrollment; and GI=Guarantee-issue.

Small-Group Market Reforms

Rating Structure—+/- X%=Rate bands of plus or minus the specified percentage of the indexed rate; NRS=No rating structure; CR=Community rated; and MCR=Modified community rated.

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