Ensure fair insurance premiums for small groups. There are strict limits on:

• How much insurers can charge sicker groups

• Premiums for similar employers can only vary +/- 25% from an average rate based on health-status or claims experience.
  
  
• Limits on other rating factors: 4:1 for age; +/-15% for group size; industry is prohibited

• How much insurers can increase an employer's premiums when an employee gets sick

• Renewal rating follows same rules as initial rates

• How often rates can increase (every 12 months)
  
  

No

No

No

Ensure access to independent review:

• Consumers can demand independent external review of claims denials
  

No

Ensure appropriate access to care. Insurers must:

• Cover emergency services that a “prudent layperson” thought necessary
  
  
• Allow direct access to OB-GYNs
  
  

No



No

Ensure marketing protections:

• Insurers must follow detailed requirements for marketing materials

No

Ensure health plans cover important benefits, such as:

• Mental health parity that goes beyond federal requirements*
  
  
• Mammography screening
  
  
• Prompt payment rules
  
  

No

No

No (Self-funded AHPs exempt)

Ensure appropriate oversight of insurers:

• State handles complaints from consumers & providers
  
  
• State investigates, oversees, enforces rules (including financial penalties)
  
  
  

No



No$

Prevent failures and ensure payment of claims:

• Insurers must maintain financial surpluses that grow with size of insurer
  
  
• State oversees corrective action once insurer nears minimum standards
  
  
• State acts quickly to seize assets to pay claims
  
  
  

No ($2M cap)


No


No

Promote access for the uninsured:

• Insurers must help fund state high-risk pool
  
  
  

No