Do health premiums go up if an employees spouse gets large treatments for things such as cancer?

  • by Jamelyn Swinney
  • Jun 16,2018
  • 12 answers

Do health premiums go up if an employees spouse gets large treatments for things such as cancer?


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Insurance Answers (12)

David 14 3 months ago

It may or may not be true depending on the insurance company and their contract with the employer.

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mbrcatz 3 months ago

For employee groups under 25 people, the entire group is "rated" based on the history of the group. It doesn't matter who filed the claims - if the group as a whole is losing money for the insurance company, the group as a whole will receive a price increase. It is, however, unethical for ANYONE to announce who in particular made the rates go up. This was a violation of protected health information, announcing that the spouse has cancer.

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Flower 3 months ago

You have to find out how your particular employee plan works. Ask that question. Or go to the Obamacare site and read the benefits.

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STEVEN F 3 months ago

ALL insurance rates are determined by the average claims of those insured. It is not only ethical, but financially MANDATORY to raise premiums with total claims in order to avoid BANKRUPTING the plan.

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NA 3 months ago

A side note. Many companies self insure. They hire an insurance company to process the claims, but pay the bill. IMHO, small companies under estimated the likelihood of 2 or more employees getting cancer in one year.
I worked at a firm that changed "coverages" each year in their attempt to keep costs down. We would joke, who saw a chiropractor last year? It's not covered any more. Back in the 1980s when AIDS first hit, policies suddenly had retroactive caps of, say, $100,000 in lifetime benefits. One guy sued all the way up to the Supreme Court over it and the court ruled the arrangement was a) legal and b) not insurance.

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Insurance Pickle.com 3 months ago

For larger companies, the experience rating of the group (the claims) are part of the determination of the claims for the following year. But, they'd never be for that one person. The rate increase would affect the entire group. We had a group that had $500,000 of claims on $350,000 of premiums and their premiums didn't increase at all the following year. More than likely the underwriters determined the claims to be temporary and not ongoing.
For small companies and individuals, technically the same thing happens, but it's spread across a larger pool. However, when you throw 10,000 people into the pool with cancer, heart issues, kidney issues, etc...you see the premiums rise pretty dramatically -- as we did.

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sats 3 months ago

Yes, insurance companies are not in the business of losing money. They will make premiums go up if you use their service.

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curtisports2 3 months ago

Not true. Company group insurance premiums are set once a year. They do not go up for one person based on that one person's record.

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Elijah Tenenbaum 3 months ago

It will now.
Obama care prohibited that kind of thing.
Trump is killing off those protections...making sure sick people die rather than have a shot at living.

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Christina 3 months ago

yes. the health insurance will never lose a dime for you. even at the premium you have now they are turning a profit.

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L. E. Gant 3 months ago

It depends on the group you belong to. Premiums are set so that the insurance company does not lose money in the long run, so, if in a group, there are huge expensive treatments, the premiums for the whole group increase. The increase is not immediate, even for individual cases (ie not within a group), so it's at the next round of negotiations that the increase occurs.
Note that if you have a few thousand people in the group, the increase will look extremely small, so, with 10,000 people as an example, the extra costs will probably result in a couple of dollars per year increase in premiums, while with the individual, it might be $100 per year.

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Liberals Are Nuts 3 months ago

Depends on the type of coverage you have. With most company coverage the rates stay the same.

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