Health Insurance Regulation:

Variation in Recent State Small Employer Health Insurance Reforms

HEHS-95-161FS: Published: Jun 12, 1995. Publicly Released: Jul 12, 1995.

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Pursuant to a congressional request, GAO provided information on state legislation to improve portability, access, and rating practices for the small-employer and individual health insurance markets.

GAO found that: (1) no state entirely adopted the National Association of Insurance Commissioners' (NAIC) model small-employer health insurance act; (2) the states did not consistently define small employers, eligible employees, carriers, and noncarrier groups offering small-employer insurance; (3) only 20 states included the self-employed, and not all of those states extended all provisions to that group; (4) 15 states passed some type of individual market reform, and 10 closely applied their small-employer reforms to their individual reforms; (5) states had the most difficulty in defining noncarrier groups offering insurance; (6) most states included limitations on preexisting condition exclusions and portability requirements, but differed on the length of the waiting period; (7) most states restricted insurer rating practices, but either significantly changed the NAIC model provisions or used a different approach; (8) states' approaches to rate determinations, permissible premium variations, and the number of carriers' business classes varied significantly; and (9) NAIC amended its model act to redefine small-employers to include the self-employed.

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