New York Health Insurers Propose Hikes for Individual, Small Group Rates

By | May 20, 2016

New York health insurers have proposed premium increases averaging 17.3 percent for next year in the market for individuals and 12 percent for small groups.

The New York State Department of Financial Services often reduces proposed increases before approving them. Approved rates are expected in early August.

The amounts posted Wednesday by the department are averages for an insurer’s various plans, including those offered on the New York Health Exchange.

In the individual market, they range from 6.1 percent by MVP Health Plan and HealthNow New York to 89.1 percent by Crystal Run Health Plan.

The small group proposals range from 5 percent for Healthfirst Health Plan to 61.9 percent for Crystal Run.

The New York Health Plan Association said Wednesday the higher premiums are necessary for the financial stability of New York’s market.

“The 2017 rate submissions reflect increases that are the direct result of the underlying cost of care and marketplace changes that continue to impact health plans’ operations,” said Paul Macielak, association president. Those include rising drug costs, health plan losses for 2015 on individual plans and higher than expected use of covered services, he said.

Other proposed rate increases in the individual market include 45.6 percent by United Healthcare of New York, 29.2 percent by North Shore-LIJ CareConnect Insurance Co., 15.9 percent by Excellus Health Plan and 8.1 percent by Fidelis Care New York.

For 2015, the department approved an average premium increase of 5.7 percent, cutting the companies’ average requested increase of 12.5 percent by more than half.

The association said that while the insurers must include actuarial assumptions and methodologies to support their premium proposals, the department has not provided similar information in its determinations although required by law to do that.

Spokesman Richard Loconte said the department’s primary responsibility is to ensure fair consumer rates and insurer solvency. Final rate determinations “are based on sound actuarial processes” as required by law, while each aspect of its rate decisions is set forth in written online summaries, and staff answers any insurer’s questions about its determination, he said.

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