North Dakota Health Insurance Questions on Pregnancy, Premiums & More

I just found out I am pregnant. I do not have maternity benefits in my insurance policy. Will I or my baby have any coverage at all?

North Dakota statute does not mandate that maternity benefits be available on every policy. Therefore, if you have not purchased maternity benefits on your policy, there will not be coverage for prenatal or postnatal care for the mother. Nor will there be coverage available for the delivery of your baby.

However, there are statutes in place that mandate coverage for complications of pregnancy. All policyholders need to reveiw the definition/provision for "Complication of Pregnancy" in their respective policies.

I have just received notice that my health insurance premium is going up. I have not had any claims. How is my company justified in raising my rate?

Even though you have not had any claims, the theory of insurance involves the pooling of a large number of similar risks, thereby transferring the uncertainty related to the risk from the individual to the insurance company in return for premium. In this way, the insured person pays a small, immediate known loss (the premium) in return for relief of worry from a possible, large, further loss such as a health claim.

Companies requesting rate increases or decreases for health insurance are required to submit supporting decumentation to the North Dakota Insurance Department proving that the rate increase requested is not excessive, inadequate, or unfairly discriminatory. The Department then must analyze the filings to determine if the rate requested is justified.

Companies writing health insurance in North Dakota can revise rates based on the company's "experience" in North Dakota. Experience is the data collected by an insurance company that takes into account premiums collected and claims paid. For every premium dollar received by a health insurance carrier, approximately 75 cents is used to pay for claims and claims processing. The balance of 25 cents goes to pay agents' commissions, general operating expenses, and taxes. If the company is a for-profit organization, state law allows the private company to earn a reasonable profit.