How does a health carrier get a rate increase approved?

Health carriers must submit rate change requests to DIFS via SERFF, an electronic filing system. The carrier must provide documentation to support its request. This will include data regarding the costs and use of health services they have reimbursed during the experience period (usually the prior 1-2 year period) . The health carrier must then estimate future costs/utilization, based on the changes in costs over a period of time, called a ‘trend'.

Depending on the type of health policy, DIFS is allowed between 30 and 60 days to review the rate increase request and make a final determination whether to approve.