Harvard Pilgrim Health Care
Rate Justification for New Hampshire Individual Plans
Rate Change Effective January 1, 2022
Qualified Health Plan (QHP) issuers are required to post justifications for any QHP rate changes to their websites. Below, please find the justification for the rate change effective January 1, 2022 for the Harvard Pilgrim Health Care (HPHC) New Hampshire Individual QHP plans.
Drivers of the rate change
- A key driver of health insurance premium increases year over year is medical trend, which is comprised of inpatient, outpatient, and physician services as well as pharmacy costs. Medical trend includes both increases in the cost of the services provided by hospitals and physician groups and increases in the utilization of these services by our members.
- HPHC has not explicitly reflected any rate impact related to COVID-19, except to cover the expected costs associated with vaccination.
- Effective January 1, 2021, the New Hampshire Insurance Department began operating a reinsurance program with the goal of lowering insurer liability for Individual Plans. HPHC’s rate change reflects the impact of this program.
Under the Affordable Care Act, at least 80% of premium must be used for medical expenses (otherwise, a rebate is paid to subscribers). The 2022 rate changes were calculated to comply with this requirement.
Harvard Pilgrim’s Strategy to Keep Premiums Affordable
Harvard Pilgrim is committed to improving value and quality across the health care system. Some of the ways we are working to meet our goals include:
- Establishing collaborative arrangements with providers that control costs and enhance health outcomes
- Negotiating pharmacy contracts aligning payments with outcomes
- Managing rare diseases through our nurse care managers
- Updating our payment policies to deter inappropriate payment for services on selected medical infusible drug claims
- Maintaining focus on reducing fraud, waste and abuse
Continuing to find ways to lower health care costs while providing enhanced value to our customers through our products and services is a keystone to our organization’s long-term strategy.
The combined organization of Harvard Pilgrim and Tufts Health Plan is committed to guiding and empowering healthier lives for everyone
Harvard Pilgrim’s commitment to its members, customers, communities and provider partners has never been stronger. It has included financial support to independent primary care practices and community health centers, as well as the waiver of telehealth and COVID-19 testing and treatment cost sharing. From the start of the COVID-19 pandemic, Harvard Pilgrim Health Care, through its Foundation, quickly responded to the immediate needs facing nonprofit partners and communities throughout New Hampshire. Since the beginning of 2020 through August 2021, our organization has provided more than $2.16 million in grants to more than 37 nonprofit organizations in New Hampshire to help strengthen and respond to communities in need. This support included food access, meal delivery, services for older adults and immigrant families, social and community services, and emergency response.