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Health benefit plans purchased for new coverage starting January 1, 2014 or later are fully ACA-compliant (Affordable Care Act compliant). ACA-compliant plans will have an associated “metal level” of Bronze, Silver, Gold, Platinum, or Catastrophic, and they offer at least the Essential Health Benefits package.

The Department of Insurance received the preliminary 2016 health plan information on May 1 and proceeded to review the proposed plan documents and rates for compliance with Idaho and Federal regulations. The Department of Insurance does not have the authority to disapprove or establish insurance rates, but it does have the authority to deem rate increases submitted by insurance companies as unreasonable. After the review and negotiation process, the carriers have submitted their final rate increase information. While the Department is disappointed with the large increases of some carriers, the Department did not find the final rate increases to be unreasonable.

The carrier specific rate increases shown below are composites. The premium increase for an individual or family may vary greatly, based on the geographic area, choice of plan, changes in enrollees or ages, eligibility for the advanced premium tax credit, and other factors.

Insurance Company Preliminary Final
Altius Health Plans Inc. 8%11%
Aetna Life Insurance Company 6%8%
Blue Cross of Idaho Health Service, Inc. 13%11%
Mountain Health CO-OP 25%27%
PacificSource Health Plans, Inc. -8%-8%
Regence BlueShield of Idaho 1%1%
SelectHealth 7%7%
UnitedHealthcare Insurance Company 4%4%
WMI Mutual Insurance Company 5%5%

Each insurance company that submits a rate increase of 10 percent or greater must also submit a consumer-oriented explanation, which is available by clicking on the name of the insurance company above. A key driver of all the increases is the level of health claims paid compared to the premium collected in the prior year.

In addition to paid claims, the premium should cover the administrative costs, insurance fees, and taxes. The ACA restricts administrative costs to no more than 20 percent of the premium. Larger rate increases may be needed when the prior year's premium is not sufficient to pay for the health claims and administrative costs and fees. Please see an individual company's explanation by clicking on the company name above for more information about a specific rate increase.