Underwriting in the Non-Group Health Insurance Market: The Fundamentals

Non-group health insurance is coverage that individuals purchase on their own rather than as part of a group. Most states currently permit non-group insurers to underwrite, a process whereby an insurer assesses the health and other characteristics of individuals to determine their likely utilization of health services or risk; insurers then use this assessment to determine whether they will offer coverage and the premium they will charge. Policymakers have identified underwriting and related practices in non-group markets as a target for reform to enable broader access for the currently uninsured. This publication reviews the characteristics of non-group markets and insurers\u27 strategies for managing risk presented by people seeking non-group coverage. It also outlines relevant non-group market rules now in force in the states and considers how national rules might affect current markets