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Like many business sectors, health insurers are subject to state regulations that govern their operations, and each state has its own set of rules. States typically oversee individual and small group premium rates, establishing a rate review process and seeing that process is met. They typically require detailed documentation to support and explain changes in rates, including data about medical claims and administrative costs. Additionally, insurers are required to explain how premium dollars are spent and document that they are financially sound and able to meet claims for payment.
As with most documents required by government agencies, rate and/or financial filings are a matter of public record, depending on the laws of each state.
This "Common questions" list gives a brief overview of the breadth of Oregon's oversight of health insurers for such issues as:
"Health Insurance In Oregon" is a comprehensive look at the state's top seven health plans and their finances.
Washington has a "Patient's Bill of Rights" that addresses many insurance company practices, including:
Washington helps consumers compare the efficiency and financial condition of health plans.
Also, Washington State requires that private insurers accept 92 percent of individual applicants (those seeking non-employer based coverage), and assesses a levy on health plans to fund a high-risk pool for persons who cannot qualify for private coverage.
Almost half of the national health expenditure, expected to near $3 trillion in 2011, is spent through federal programs covering about one in three Americans. These are administered by private sector health insurers, like Regence, according to the rules of each agency:
Numerous federal agencies will be involved in setting rules to implement the Patient Protection and Affordability Act, passed by Congress on March 23, 2010.