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Rules Governing California's Small Group Health Insurance Market

Debra L. Roth

This issue brief describes the rationale for having special rules that apply to the small-group health insurance market, summarizes California's small-group market rules, and puts these rules in the broader context of other market forces.

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June 2003

California's small-group health insurance market is regulated by a special set of rules designed to strike a balance between the broad social goal of allowing small employers fair access to health coverage and the needs of insurance carriers to avoid unpredictable costs. This issue brief describes the rationale for having such laws, summarizes the rules that applied to California's small-group market at the time, and places small-group rules in the context of other market forces.

California law governing the small-group market affords several key protections, including guaranteed issue, rating protections, portability, and fair marketing provisions. The issue brief defines these protections and discusses their implications. Rating terminology is also defined and some sample rating calculations are provided.

The complete issue brief is available under Document Downloads below.