Health Insurance Regulations by State

If you have ever had to deal with health insurance for your family or your business, you know that it can be an extremely complicated endeavor which generally isn’t a whole lot of fun. What most people don’t realize is that a lot of the costs, rules and details involved are due to various health insurance regulations by state which can change depending on where you are in the country. The federal government has delegated much of the responsibility involved in dealing with and regulating health insurance to the states, which in turn create laws around everything from mandated benefits to provider due process laws.

In this article we will take a look at health insurance regulations by state and how these can greatly impact your health insurance policy.

How do these state health insurance regulations work?

Currently, health insurance is regulated quite heavily at the state government level. Some states have taken it upon themselves to make very strict rules around health insurance offerings, including dictating to providers what they must cover, what type of medical facilities must be included in their coverage plans, and more. While some believe this is the correct way for states to go in regards to health insurance, others believe that the higher costs end up pricing individuals out of the health insurance market altogether.

Health insurance regulations by state are generally meant to control certain aspects of the health insurance industry to ensure that things don’t get out of hand. States may try to control health care costs that are spiraling out of control, or perhaps enforce that providers must extend coverage to individuals that they normally wouldn’t take the risk on. Each of these decisions causes change in the system; for instance, if health insurance regulations by state demand that unhealthy or higher-risk individuals should be allowed to access low-cost health insurance, then logic dictates that the price for health insurance will increase for everyone who’s part of the plan.

Group Health Insurance Regulations by State

As businesses tend to spend incredible amounts of money on health insurance, it’s critical that they are made fully aware of group health insurance regulations by state and how it can affect the providing of benefits to employees. Even minor changes in group health insurance regulations by state can have a drastic increase in costs, which in turn can cause companies to reduce employee health insurance benefits or eliminate them altogether.

Health plan liability laws are certainly one set of health insurance regulations that companies want to know inside and out. These laws dictate circumstances where the employer can be liable for their employees’ health insurance, and breaking these laws can result in damages or fines.

Individual and Family Health Insurance Regulations by State

Health insurance regulations by state also affect individuals and their family health plans as well. Mandated benefits are the most likely to cause confusion and higher costs amongst individuals, as these vary widely on a state-by-state basis and can be very tough to figure out. Essentially, state governments decide that certain illnesses or treatments – which typically do not affect the entire population of health insurance policy holders – must be covered under every policy in the state. This then creates higher costs for everyone, and sets up a perception of unfairness in how the health insurance system works in that state.

For instance, some health insurance regulations by state mandate that plans must provide coverage for treatments related to hair loss. While hair loss can be a bit of a downer for those that have to deal with it, in nearly all cases it is harmless and is rarely ever life threatening. Another very polarizing issue is the mandated benefits around morbid obesity treatments. While it’s certainly of benefit to help individuals return to a healthy weight, many argue that they shouldn’t be paying more for their health insurance because others choose to have an unhealthy lifestyle.

What can I do about these regulations?

The most important step is educating yourself or your company’s insurance team on health insurance regulations in your state. By knowing what the boundaries are, one can tailor their health insurance plans and premiums as much as possible to ensure that they are getting the best health insurance coverage at the best possible price. If you’re disappointed or angered about health insurance regulations by state, the best place to look is your state representatives and governor. Don’t be shy about writing a few letters to express your feedback and changes that you would like to see.

SelfHealthInsurance.com is here to assist you with getting the best possible deals for your health insurance, regardless of what state you might live in! To get started with finding some great price quotes, scroll up to the top of this page and enter your ZIP code in the form. It’s that easy!

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  1. [...] plan can save in the long run. Most states exempt self funded health insurance plans from benefits regulations and taxes which can save hundreds to thousands per year [...]

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