State RegulationsNY specificDifficulty 2/5
Under the Affordable Care Act, which factor may an individual-market health insurer in New York still use when setting a new applicant's premium?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under the Affordable Care Act, individual-market premiums may vary only within limits, based on a small set of permitted factors: age, tobacco use, geographic rating area, family size, and the plan's metal level. Health status, claims history, gender, and preexisting conditions may no longer affect the premium. The New York Department of Financial Services supervises rate filings that apply these limits to coverage delivered in New York.
Why the other options are wrong
- A) Preexisting conditions can no longer influence premiums; guaranteed issue bars health-status rating.
- B) Prior claims history reflects health status, a prohibited rating factor under the act.
- D) Coverage lapses are not among the permitted premium factors, and the act bars health-based penalties for them.
Memory hook
Age, tobacco, area, family, metal level - the only premium dials the ACA left.