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Life Health > Health Insurance

Golden Rule shows what PPACA did to claims

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Golden Rule Insurance Company has published some 2014 health claim data in a Connecticut rate filing.

Health insurers have used 2013 experience data in most individual rate applications filed up until now. Golden Rule was an application that includes some 2014 data because the policies affected have an experience period that runs from July 1 through June 30.

Golden Rule, a unit of UnitedHealth Group Inc. (NYSE:UNH), filed the application for a group of grandfathered individual policies that cover 2,342 people in Connecticut. The company wants to increase rates an average of 19 percent.

A grandfathered policy is a major medical policy that’s exempt from many of the Patient Protection and Affordable Care Act (PPACA) provisions that apply to new policies. Although PPACA does not apply directly to most grandfathered policy provisions, it has affected the nature of people covered by the grandfathered plans.

PPACA encourages moderate-income people who can qualify for subsidies to get coverage from the PPACA public exchange system, but the structure of the exchange system may encourage people with health problems who want to see the same provider to stick with grandfathered plans. Regulators have shut grandfathered plans out of the major PPACA risk-management programs.

See also: PPACA ‘grandmothering’ bill heads to House floor.

A Golden Rule historical experience table shows monthly experience data for months from January 2013 through June 2014.

Golden Rule says it expected to have a loss ratio of 60 percent from 2001 through June 2014 but had an actual incurred loss ratio of 66 percent.

The incurred loss ratio in 2012 wsa 73 percent.

From January 2013 through December 2013, monthly incurred loss ratios ranged from a low of 67 percent in August to a high of 123 percent in December.

From January 2014 through June 2014, monthly incurred loss ratios ranged from a low of 58 percent in May to a high of 140 percent in January. The loss ratio has been lower than 75 percent every month since January.


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