Small-Group Session

Issues in Health Insurance Reform: The Nuts and Bolts of Rating Rules in the Individual Insurance Market
February 19, 2009


Sally Coberly, PhD


This small-group workshop provided an in-depth examination of rating practices in the individual insurance market. The session focused on the differences between adjusted community rating and rate bands and the significant variation in how states implement and enforce rating bands. Rating factors, such as age, gender, and geography were discussed; the impact of product type such as HMO or PPO, plan design features, and networks on risk segmentation were also described. Strategies for mitigating risk segmentation, such as using stricter minimum provider standards were explored. The experiences of insurers offering individual coverage in New York State, which has operated under pure community rating and guaranteed issue with risk adjustment mechanisms since 1993, were also reviewed.


John M. Bertko, FSA, Adjunct Staff, The RAND Corporation; Geoffrey C. Sandler, FSA, MAAA, Staff Vice President and Actuary, WellPoint, Inc.; Mary Beth Senkewicz, JD, Deputy Commissioner of Life and Health, Office of Insurance Regulation, State of Florida; Gary Claxton, Vice President and Director, Health Care Marketplace Project, Henry J. Kaiser Family Foundation

Slides from the presentations by Mr. Bertko and Mr. Sandler are available for download. Speakers' biographies are also available.

Related Materials

Other recent meetings in the Forum's series on health insurance reform include sessions on underwriting, rating, and regulation in the individual market (December 3, 2008); health insurance exchanges (March 6, 2009); risk adjustment and rating in the small-group market (March 20, 2009); actuarial equivalence (April 7, 2009); health insurance exchanges, part II (April 15, 2009); and federal/state regulatory roles, subsidy administration (May 8, 2009).

For more information about rating reform in New York, see "The Impacts of Guaranteed Issue and Community Rating Reforms on Individual Insurance Markets" (August 2007).

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