What is a Premium in Health Insurance?

  • September 13, 2016
  • |Quartz
This is a blog post. The information may not be up-to-date. If you have questions, please contact Customer Service
Learn more about what a health insurance premium is and the average cost of one in Wisconsin.

A health insurance premium is the monthly payment made to the insurance company to maintain health insurance coverage.

If your health insurance coverage is a benefit you receive from your employer, the employer may pay all or a portion of the premium to the insurance company.

If your employer doesn't provide insurance coverage or you’re self-employed, you probably purchased a plan directly from an insurance company and you pay your premium to the health insurance company.

What is the average health insurance premium in Wisconsin?

The latest information shows that the average health insurance premium in Wisconsin ranged from $314 for a bronze plan to $475 per month for a platinum level plan in 2016.1


Not paying your premium by the due date is one of the few reasons your health insurance company can cancel your plan. By law, they must give you at least 10 days notice before they can cancel your coverage. This is called a “grace period.” However, if you have claims in process and you don’t pay your premium before the end of your grace period, your claims will not be paid and you will be liable for those costs. If you pay your premium before the grace period expires, you keep your coverage.


Not within the plan year unless you have a change in your status, such as adding dependents. Each year, the insurance company can change your health insurance premiums at renewal. By law, they can’t raise your premium more than 10 percent without publicly justifying the increase. In addition, health insurance companies must use at least 80 percent (on small group and individual products and at least 85 percent on large groups) of your premiums to pay for your health care and to pay for quality improvement activities. If this is not the case, the insurance company must provide a rebate.*

*The rebate is provided to the member only for the amount of premium below the 80 percent Medical Loss Ratio mark and not a full refund of premiums paid. Also, this does not apply when an insurance company has fewer than 1000 enrollees in a particular state or market.

Wondering what your health insurance premium could be? Get a quote or talk to our knowledgeable and friendly customer service representatives at 800.362.3310. They’re happy to help!

  1. http://www.commonwealthfund.org/interactives-and-data/maps-and-data/health-insurance-marketplace-premiums


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