OCI > Comprehensive Health Insurance Rate Filing Information

Comprehensive Health Insurance Rate Filing Information

Last Updated: October 28, 2024

The Office of the Commissioner of Insurance reviews all comprehensive health insurance rates for policies sold to individuals and small employers in Wisconsin. This allows OCI to ensure the rates charged by the company reflect the true cost of the benefits included in each health plan and the company's costs of operation.

Comments or questions about health insurance rates can be emailed to OCIRateReview@wisconsin.gov.

How can I access rate filing information?

A brief summary of rate filing information for each insurer offering plans in the Wisconsin individual market for Plan Years 2024 and 2025 is available below. The content will not appear correctly in Internet Explorer, please use Chrome or Firefox to display this page.

Consumers can search for additional company-specific rate filing information by state, market (individual or small group) and year, by visiting the following federal web site: RateReview.HealthCare.gov. Proposed rate information for the upcoming plan year is posted each year on or around August 1^st. Final rate information is posted on November 1^st.

After November 1^st, and in accordance with Wisconsin's public access laws, comprehensive health insurance filings are also available via OCI's Policy Forms and Rate Filings Search web page.

To view a list of Wisconsin comprehensive health rate filings, click on the desired year below:

Are rates the same as premiums?

No. Information in health insurer rate filings is calculated using a weighted average based on a geographic distribution of all offered plans. As a result, the average rate change shown may be very different from a specific consumer's actual premium.

What affects the premium I pay if I have an individual (non-employer) plan?

Your premium starts with the rate for your specific plan–based on the benefits available and the network of doctors and hospitals you can access. It then varies based on your age (and the ages of any family member(s) in your plan), where you live, and whether you use tobacco. A health insurance company cannot vary your premium based on your “health status" or that of your family members. Depending on your income, you may be eligible for a premium subsidy.

What affects the premium charged for my small group (2-50 employees)?

Your group's premium starts with the rate for your specific plan–based on the benefits available and the network of doctors and hospitals you can access. It then varies based on the employees' ages (and the ages of their family member(s) in the plan), whether employees and dependents over 18 use tobacco, and the main address for your company. A health insurance company cannot vary the group's premium based on the “health status" of employees or that of their family members.

Can my insurance company change my premium?

An insurance company may change an individual's/employer group's premium in the following circumstances:

The plan is up for its annual renewal;
An individual/employee requests to add or remove a family member from the policy;
An individual/employer decides to change plans or plan options at renewal (different benefits, network, or cost-sharing);
An individual is no longer eligible for the same amount of premium subsidy from the federal government; or
An individual or employer's main office moves to a different county in Wisconsin.

What if I can't afford the premium for my current plan anymore?

Each year, you have the opportunity to change your health insurance company and/or plan during a time called “open enrollment." During this time, you can shop for new health insurance coverage that best fits your needs and the needs of your family. This year's open enrollment period is November 1^st through December 15^th.

It is important to remember that your cost may vary under different policies. When shopping for a new plan, you will want to consider the deductible and the copay or coinsurance you would pay when you use your health care, as well as the premium you pay each month. For example, if your family needs a lower deductible, you will likely pay more in premium. “High-deductible" plans would have a lower premium.

Depending on your family's income, you may also be eligible for premium subsidies from the federal government. To determine your eligibility, visit HealthCare.gov.

What if I my employer decides not to offer health insurance any longer?

Each year, employees and family members have the opportunity to find health insurance coverage during “open enrollment." At this time, you can shop for new health insurance coverage that best fits your needs and the needs of your family. This year's open enrollment period is November 1^st through December 15^th.

In some circumstances, such as losing health coverage, getting married, having a baby, getting divorced, adopting a child, moving outside a health coverage area, changing income levels, or experiencing a death in your family, you may also be eligible for a “special enrollment" period. Contact your insurance agent, insurance company, or visit HealthCare.gov for more information about special enrollment. You could qualify for continuation coverage (e.g., COBRA) or an individual health plan.