Maryland Life and Health Insurance License Practice Exam

Under what circumstance can an insurer increase premiums on group health plans?

1. Failure in claim usage data

2. Changes in regulations

3. Industry-wide cost increases

4. Evidence of fraud

The correct answer is: Industry-wide cost increases

An insurer can increase premiums on group health plans due to industry-wide cost increases. This situation acknowledges that fluctuations in healthcare costs can impact insurance pricing. When the overall costs of healthcare rise due to factors such as increased medical expenses, higher prescription drug prices, or general inflation in healthcare services, insurers may adjust premiums accordingly to maintain their financial viability and ensure they can cover the claims effectively. In contrast, other circumstances may not be valid reasons for increasing premiums in the same way. For example, while failure in claim usage data might influence an insurer's assessment of risk, it wouldn't directly justify a premium increase. Changes in regulations could require modifications to coverage or benefits but do not inherently lead to premium increases unless they result in higher costs. Evidence of fraud is a serious issue that may lead to claims denial or cancellation but wouldn't typically be used as a reason to increase premiums for an entire group plan. Therefore, industry-wide cost increases represent a legitimate and common rationale for insurers to adjust premiums.