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Health Insurance Education: The Rate* Review Process
*Rates and Premiums

A "rate" is the base price of a health insurance plan. These rates are filed by the carriers and reviewed by the Department of Banking and Insurance (DOBI). 

A "premium" is the actual amount an insurance company charges per month for a health insurance plan, which can differ from the rate based only on age (for individuals and small employers) and county (for small employers).

Rate Review Process

New Jersey laws governing the Individual Health Coverage (IHC) and Small Employer Health (SEH) Benefit markets require carriers to submit informational filings of their rates for IHC and SEH plans with DOBI who reviews the rate filings for compliance with State and Federal law.  Rate filings that satisfy all applicable requirements are not “approved” but are rather found complete.  DOBI has the authority to disapprove any rate filings that are inadequate, unfairly discriminatory, incomplete or not in substantial compliance with the law.

DOBI’s rate review process determines if a rate change is not in substantial compliance with the law if, for example, the change:

  • is based on faulty assumptions or unsubstantiated medical trends;
  • would charge different rates to people who pose similar risks;
  • does not meet Minimum Loss Ratio (MLR) standards (requires 80% or more of premium to be used for the payment of claims); or
  • does not comply with permissible rating factors.

The DOBI rate review process focuses on improved carrier accountability and transparency, and makes information about rates transparent and available for consumers through  It ensures that experts evaluate whether the proposed rate changes are based on reasonable cost assumptions and solid evidence and gives consumers the chance to comment on proposed increases.  In our role of assisting consumers, DOBI:

  • Responds to inquiries about rates for various forms of health insurance, including IHC and SEH, Medicare Supplement, Student Health Plan (SHP) and Long Term Care (LTC);
  • Monitors public comments on rates; and
  • Reviews rate filings to monitor the quality of information provided by the carriers and to ensure compliance with all applicable laws.

Since 2011, the DOBI rate review process was recognized by the Federal Department of Health and Human Services, as meeting the Affordable Care Act (ACA) requirements to be an Effective Rate Review Program with regards to NJ’s IHC and SEH markets.

If you have any feedback or comments regarding the rate review information provided here or premium rates for IHC or SEH coverage, please e-mail: E-mails sent to this address will generate an automated response.

For complaints about rates (or your premium), click here. Complaints and inquiries are handled through a separate unit.  If you are filing a Complaint, or have an Inquiry, about any type of insurance, including Long Term Care, please use the Insurance Complaints / Inquiries process to ensure your receive a response.
Rate (Premium) Information:

The Individual Health Coverage (IHC) Program Rates

The Small Employer Health Benefits (SEH) Program Rates

Consumer Assistance

Consumer Resources

Information and resources about other NJ programs which may be of assistance are available here:

Additional Rate Review

The Affordable Care Act (ACA) requires that carriers planning to significantly increase plan premiums submit a justification of the rate increase to federal government.  Although the rate increase threshold for 2019 has been increased to 15%, New Jersey continues to apply a 10% threshold for filing rate increase justifications over a 12-month period.

The ACA also requires that a summary of rate review justification and results be accessible to the public in an easily understandable format, which may be found at:

Options for Health Insurance

Small employers may qualify for Federal tax credits that make it more affordable to provide health insurance to their employees.  Further information is available at:

Individuals may find details on the types of health insurance plans best suited to their needs and the associated costs at:

National Association of Insurance Commissioners (NAIC) NAIC Insure U
The National Association of Insurance Commissioners is the organization of insurance regulators from the 50 states, the District of Columbia and U.S. territories. It publishes consumer information on a variety of insurance-related topics, including addressing Frequently Asked Questions about health care reform.
OPRA is a state law that was enacted to give the public greater access to government records maintained by public agencies in New Jersey.
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New Jersey Department of Banking and Insurance