Individual Health Insurance Market Reform

Community Rating: Requires insurers to charge everyone the same premium rate. The premium is not permitted to vary according to the actuarial risk presented by an individual.

Adopted by 10 states: ME, MA, NJ, NH, NM, NY, ND, OR, VT, WA

Pre-Existing Condition Exclusion Limit: Limits the amount of time a health insurance carrier can exclude coverage for a condition that was that was already present prior to the start of the effective date of new coverage.

Adopted by 31 states: CA, CT, FL, GA, ID, IN, IA, KY, LA, ME, MD, MA, MI, MN, MS, MT, NH, NJ, NM, NY, ND, OH, OR, SC, SD, UT, VT, VA, WA, WY

Guaranteed Issue: Requires insurance carriers to offer coverage to small groups and individuals regardless of claims history or health status.

Adopted by all 50 states + District of Columbia

Guaranteed Renewal: Requires carriers to renew policies with small groups or individuals regardless of claims experience.

Adopted by all 50 states + District of Columbia

Sources: Analysis of State Legislative Health Care and Insurance Issues: 2003 Survey of Plans, December 2003, BlueCross BlueShield Association by NETSCAN iPublishing Inc., Health Policy Tracking Service, 2004