Can a health insurance issuer charge an employer different premiums for each individual within a group of similarly situated individuals based on each individuals health status?
No. Issuers may not charge or quote an employer or group health plan separate rates that vary for individuals (commonly referred to as list billing), based on any of the health factors. This does not prevent issuers from taking the health factors of each individual into account when establishing a blended, aggregate rate for providing coverage to the employment-based group overall. The issuer may then charge the employer (or plan) a higher overall rate, or a higher blended per-participant rate. While HIPAA prohibits list billing based on health factors, it does not restrict communications between issuers and employers (or plans) regarding the factors considered in the rate calculations.
