New Jersey Individual Health Insurance Ratings & Rate Changes

Rating

Modified Community Rating for Standard Plans:

Carriers have the option to use modified community rating for the standard plans. The rates may vary based solely on age. Rates vary from carrier to carrier and from one individual plan to another. That is, one carrier's price for Plan D is not likely to be the same as another carrier's price for Plan D. And, because Plan D has a higher carrier coinsurance than Plan B, Plan D will generally be priced higher than Plan B. The list of carriers and their rates for various plans can assist those interested in purchasing individual health coverage with a comparison of rates.

Modified Community Rating for B&E Plans:

Carriers have the option to use modified community rating for the B&E plan. For the B&E plan, the rates may vary based on age, gender and/or geographic location. Carriers may use one or more of those permissible rating factors. As with the standard individual plans, the rates for one carrier offering B&E may be very different from the rates for another carrier. In addition, while the B&E coverage basically covers the same services and supplies, the addition of a carrier-designed rider to enhance the benefits under the B&E plan can result in some significant differences between the B&E plan with rider offered by one carrier as compared to that of another. Those benefit differences result in further rate differences among carriers.

Caps on Rate Increases:

As of January 5, 2009, and for the next four years, the law imposes a renewal rate cap. The renewal increase for consumers who bought a plan prior to January 5, 2009 is limited to a 15% increase. The renewal increase for consumers age 55 or older who buy a plan on January 5, 2009 or later is limited to a 15% increase. As mentioned, the cap applies only for 4 years and thus will expire in 2013.