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Regulators Weigh In On Rate Requests

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Blue Cross and Blue Shield carriers are facing resistance to rate increase requests in North Dakota and Michigan.

North Dakota Insurance Commissioner Adam Hamm has rejected a 14.8% rate increase for individual policies requested by Blue Cross Blue Shield of North Dakota, a unit of Noridian Mutual Insurance Company, Fargo, N.D.

Ken Ross, commissioner of the Michigan Office of Financial and Insurance Regulation, has reduced an increase in nongroup rates requested by Blue Cross Blue Shield of Michigan, Detroit, to an overall increase of 15.52%, from 24.3%.

In North Dakota, Hamm says he denied North Dakota Blue’s rate request because he believes the carrier did not provide enough information about payments to health care providers.

North Dakota is surprised and disappointed by the decision and expects to release a more detailed response Wednesday, a company representative says.

About 30,000 North Dakota residents have individual coverage from North Dakota Blue.

In Michigan, Ross says he gave Michigan Blue a lower rate increase than it wanted partly because he believes a shift in cost-sharing to enrollees has reduced Michigan Blue’s need for individual health coverage revenue.

Michigan Blue and the subscriber who challenged the original rate increase request can go to court to appeal the decision, officials say.

Michigan Blue has about 90,000 nongroup enrollees under age 65, and about 20,000 of those nongroup enrollees will be affected by the outcome of efforts to determine what the rate increase will be, Michigan Blue says.

The lawyer for the subscriber who challenged the original rate increase request argued that Michigan Blue’s reserves are excessive.

Michigan Blue notes that Ross did not agree with that argument.

“The decision supports Blue Cross’s argument that reserves remain well below the maximum cap set by the Michigan Legislature,” Helen Stojic, a Michigan Blue representative, says in a statement.

Stojic says Michigan Blue individual premiums are significantly lower than the individual insureds’ medical costs, because Michigan requires Michigan Blue to serve as an insurer of last resort while permitting for-profit health insurers to reject applicants who have health problems.

“This population of older, sicker Michigan residents is more costly for Blue Cross to insure, and leaves them subject to rate increases that are needed, but are higher because of this situation,” Stojic says.


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