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Review by insurance regulators of proposed premiums and premium increases. During the rate review process, regulators examine proposed premiums to ensure that they are sufficient to pay all claims, that they are not unreasonably high in relation to the benefits being provided, and that they are not unfairly discriminatory to any individual or group of individuals. Minnesota's health insurance rate review requirement is outlined in Minn. Stat. 62A.02 and 62A021.
A process that allows state insurance departments to review rate increases before insurance companies can apply them to you.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
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Health insurance premiums are calculated using many rating factors. Rating factors have much more influence on individual policy premiums than on group polices. Rating factors can include:
- Age: the older you are, the more you might pay.
- Health: the poorer your health, the more you might pay.
- Chronic conditions: having one or more chronic or existing conditions can increase your premium.
- Smoking/alcohol use: some companies charge more if you use tobacco or alcohol.
- Gender: some insurance plans charge more depending upon your gender.
- Geographic region: companies break-down coverage areas into 6-8 regions. Which region you live in can affect your premium.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
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Legislation (Public Law 111-152) signed by President Obama on March 30, 2010. One of two laws collectively referred to as the Affordable Care Act (ACA).
- Browse Related Terms: Affordable Care Act, Affordable Care Act (ACA), Grandfathered, Grandfathered Health Plan, Grandfathered plan, New Plan, Patient Protection and Affordable Care Act, Patient Protection and Affordable Care Act (PPACA), Reconciliation Act
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Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions.
Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions.
Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions.
- Browse Related Terms: Chronic Condition, Durable Medical Equipment (DME), Emergency Medical Condition, Hospice Services, Major Medical Plan, Public Health, Reconstructive Surgery, Special Health Care Need, Urgent Care
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A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral first, the plan may not pay for the services.
- Browse Related Terms: Exclusive Provider Organization (EPO) Plan, Health Maintenance Organization, Health Maintenance Organization (HMO), In-Network provider, Managed Care, Medicare Advantage, Medicare Advantage (Medicare Part C), Medicare Cost Plans, Medicare Select Plans, Out-of-network provider, Point of Service (POS) Plans, Point-of-Service Plan (POS), Preferred Provider Organization (PPO), Primary Care Physician (PCP), Referral, Third-Party Payer
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Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.
Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.
- Browse Related Terms: Court Awards, Habilitation Services, Habilitative Services, Habilitative/Habilitation Services, Health Status, Hospitalization, Rehabilitation Services, Rehabilitative/Rehabilitation Services
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Health care services that help you keep, get back, or improve skills and functioning for daily living that have been lost or impaired because you were sick, hurt, or disabled. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.
- Browse Related Terms: Court Awards, Habilitation Services, Habilitative Services, Habilitative/Habilitation Services, Health Status, Hospitalization, Rehabilitation Services, Rehabilitative/Rehabilitation Services
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A reimbursement system that protects insurers from very high claims. It usually involves a third party paying part of an insurance company’s claims once they pass a certain amount. Reinsurance is a way to stabilize an insurance market and make coverage more available and affordable.
Insurance purchased by insurers from other insurers to limit the total loss an insurer would experience in case of a disaster or unexpectedly high claims.
- Browse Related Terms: Appeal, Attest/Attestation, Carriers, Certificate of Coverage, Certificate of Creditable Coverage, Exclusions and/or Limitations, Independent Medical Review (IMR), Insurance Company, Medical Underwriting, policy, Reinsurance, Solvency, Summary of Benefits and Coverage, Summary of Benefits and Coverage (SBC)
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The amount someone pays you to use your property, after you subtract the expenses you have for the property. Royalty income includes any payments you get from a patent, a copyright, or some natural resource that you own.
- Browse Related Terms: Alimony, Cancelled Debts, Capital Gains, dividend, Income Level, Investment Income, Net Rental Income, Rental or Royalty Income, Self-Employment Income
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The retroactive cancellation of a health insurance policy. Insurance companies will sometimes retroactively cancel your entire policy if you made a mistake on your initial application when you buy an individual market insurance policy. Under the Affordable Care Act, rescission is illegal except in cases of fraud or intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage.
The process of voiding a health plan from its inception usually based on the grounds of material misrepresentation or omission on the application for insurance coverage that would have resulted in a different decision by the health insurer with respect to issuing coverage. The ACA prohibits rescissions except in cases of fraud or intentional misrepresentation of a relevant fact. Minn. Stat. 62A.04 further provides that after a health policy has been in effect for two years, no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy can be used to rescind the policy.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
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A payment or series of payments made to you after you retire from work. Generally, the amount of your income from a pension or retirement account distribution depends on the type of pension or retirement account, how much you contributed to the pension or retirement account, and whether you were already taxed on the amounts you contributed. A qualified distribution from a designated Roth account isn't required to be included in your income.
- Browse Related Terms: Annual Household Income, Modified adjusted gross income (MAGI), Pension (Retirement Benefit), Retirement Benefit (Pension), Social Security, Social Security Benefits, Social Security Survivors Benefits, Supplemental Security Income (SSI), Tax Household
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A rider is an amendment to an insurance policy. Some riders will add coverage (for example, if you buy a maternity rider to add coverage for pregnancy to your policy). In most states today, an exclusionary rider is an amendment permitted in individual health insurance policies that permanently excludes coverage for a health condition, body part, or body system. Starting in September 2010, under the Affordable Care Act, exclusionary riders cannot be applied to coverage for children. Starting in 2014, no exclusionary riders will be permitted in any health insurance.
- Browse Related Terms: Creditable Coverage, Creditable Coverage or Prior Qualifying Coverage, Disclosure, Discount Health Plan, Elimination period, Exclusion, High Risk Pool Plan (State), High-risk pool, Maryland Health Insurance Program (MHIP), Minnesota Comprehensive Health Association (MCHA), Portability, Pre-existing Condition, Pre-Existing Condition (Job-based Coverage), Pre-existing condition exclusion, Pre-Existing Condition Exclusion Period (Individual Policy), Pre-Existing Condition Exclusion Period (Job-based Coverage), Pre-existing Condition Insurance Plan (PCIP), Rider (exclusionary rider)
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A process through which insurance plans that enroll a disproportionate number of sick individuals are reimbursed for that risk by other plans who enroll a disproportionate number of healthy individuals. The ACA requires states to conduct risk adjustment for all non-grandfathered health insurance plans.
A statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
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A temporary provision in the ACA that requires plans whose costs are lower than anticipated to make payments into a fund that reimburses plans whose costs are higher than expected.
- Browse Related Terms: Advanced Premium Tax Credit, Banding, Catastrophic Plan, Consumer Operated and Oriented Plans, dependent, Hardship Exemption, Health Savings Account (HSA), High deductible health plan (HDHP), High-Cost Excise Tax, Individual mandate, MinnesotaCare, Payment Frequency, Premium Tax Credit, Risk corridor