If you buy health insurance on the individual market, without help from an employer, you may want to know what South Carolina is doing to protect you from unfair and unnecessary premium rate increases. Here’s a summary of the South Carolina laws that govern rate increases.
- South Carolina requires insurers and HMOs to obtain state approval of rate increase before they go into effect. S.C. Code Ann. §38-71-310(B); S.C. Code Ann. §38-33-80(B).
- The Director of the Department of Insurance may disapprove premium rates if “the benefits . . . are unreasonable in relation to the premiums charged.” S.C. Code Ann. §38-71-310(B); S.C. Code Ann. §38-33-80(B). For insurers, this standard is deemed to be met if the loss ratio filed with the department is “equivalent to, or greater than, the most recent loss ratios detailed within the NAIC’s ‘Guidelines for Filing of Rates for Individual Health Insurance Forms.’” S.C. Code Ann. §38-71-310(E).
- Premium rates are deemed approved 90 days after filing if no action has been taken to approve or disapprove them. S.C. Code Ann. §38-71-310(B); S.C. Code Ann. §38-33-80(C). In addition, the Director may withdraw previously-approved rates if, after holding a hearing, he determines the rates no longer meet the standard of the statute. S.C. Code Ann. §38-71-310(C); S.C. Code Ann. §38-33-80(D).
- According to the Insurance Department website, members of the public can retrieve copies of rate filings that have been “approved and closed.”