Health benefit plans purchased for new coverage starting January 1, 2014 or later are fully
ACA-compliant (Affordable Care Act compliant). ACA-compliant plans will have an associated “metal level” of Bronze, Silver, Gold,
Platinum, or Catastrophic, and they offer at least the Essential Health Benefits package.
The Department of Insurance received the preliminary 2016 health plan information on May 1 and
proceeded to review the proposed plan documents and rates for compliance with Idaho and Federal
regulations. The Department of Insurance does not have the authority to disapprove or establish
insurance rates, but it does have the authority to deem rate increases submitted by insurance
companies as unreasonable. After the review and negotiation process, the carriers
have submitted their final rate increase information. While the Department is disappointed with
the large increases of some carriers, the Department did not find the final rate increases to be
The carrier specific rate increases shown below are composites. The premium increase for an
individual or family may vary greatly, based on the geographic area, choice of plan, changes in
enrollees or ages, eligibility for the advanced premium tax credit, and other factors.
|<-- Return to Rate Review Main Menu
||Detailed Rate Increase Information by Geographic Area -->|
Blue Cross of Idaho Health Service, Inc.
|| 221,100,000|| 188,700,000
|| 77,000,000 ||77,900,000|
BridgeSpan Health Company
|| 2,500,000 ||1,400,000
|| 1,200,000 ||900,000|
Mountain Health CO-OP
|| 53,100,000 ||41,200,000
|| 16,500,000 ||15,700,000|
PacificSource Health Plans, Inc.
|| 10,900,000 ||6,400,000
|| 1,700,000 ||900,000|
Regence BlueShield of Idaho
|| 1,500,000 ||1,300,000
|| 1,800,000 ||1,100,000|
|| 99,500,000 ||55,000,000
|| 37,200,000 ||25,700,000|
Each insurance company that submits a rate increase of 10 percent or greater must also submit a
consumer-oriented explanation, which is available by clicking on the name of the insurance company
above. A key driver of all the increases is the level of health claims paid compared to the premium
collected in the prior year.
The table above shows the level of claims paid and premium collected by each insurance company
for ACA-compliant health benefit plans during 2014 and during the first four months of 2015. Please note
that Mountain Health CO-OP did not sell medical plans in Idaho until 2015, therefore their Montana claims
and premium are shown for 2014. In addition to paid claims, the premium should cover the administrative
costs, insurance fees, and taxes. The ACA restricts administrative costs to no more than 20 percent of
the premium. Larger rate increases may be needed when the prior year's premium is not sufficient to pay
for the health claims and administrative costs and fees. Please see an individual company's explanation
by clicking on the company name above for more information about a specific rate increase.
Detailed Rate Increase Information by Geographic Area
The average rate increases shown above may not be representative of the rate increases in any one
geographic area or specific health plan. The map below shows the 7 geographic rating areas in Idaho.
Detailed rate increase information is available for each rating area by clicking on one of the areas
The Department of Insurance can be reached for questions regarding this information at (208) 334-4250
or via email. Additional information is also available
through Healthcare.gov at the following links: