Can a small business pinpoint who caused their group health insurance premiums to go up?

Question

OK, I have a hypothetical scenario:

You apply for a job at a small business, and get group health insurance.

You have a lot of claims, and as a result, the insurer determines the group is higher risk and raises the rates for the group.

If you have not revealed to the employer your health problem(s), is there any way they can find out who caused their insurance rates to go up? I am concerned about (illegal) retaliation for such an event.

Answer 1

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Answer 2

The small business is not the basis of premiums. It is based on a larger group of insured and it is their claims history that affects the end premium.

In other words, your claims contribute but are not the reason for the increases.

Answer 3

It doesn't work that way.   Once the group is on a plan, the rates don't get raised for the group based on claims issues.  

The rates for the group will only go up as the rates for ALL the groups in that tier go up.  

It's not like car insurance - you don't get "surcharges" for claims.

**and to more directly come to the point, the insured - the employer - does NOT have any access to your health claims records, not even the dollar amount.**

Answer 4

Contrary to the above answers in most states a small group premium can go up based upon the claims history of the group. It is not uncommon for premium to go up two to four hundred percent just for that one group.

Because of the HIPPA privacy laws there is no legal way for a business to pinpoint who causes the premium to increase. However, in most small groups it's fairly easy to figure it out because it's usually someone who spent time in the hospital or have taken many expensive tests.

Since the premium is based upon the claims experience of the group sometimes two or three people can contribute to the increase, which can make it harder to pinpoint one person.

Discrimination laws can prevent laying off an employee due to medical conditions. You'll have to find another excuse for laying off that person. Even with that person gone it can take several years to get the premium back down unless you completely change insurance companies.