Ariz. Admin. Code § R20-6-2305 - Threshold Rate Increase Documentation Requirements

A. For a threshold rate increase, a health insurer shall submit to the Department documentation that is sufficient to allow the Department to assess:

1. The reasonableness of the assumptions used by the health insurer to develop the proposed rate increase and the validity of the historical data underlying the assumptions, and

2. The health insurer's data related to past projections and actual experience.

B. To the extent applicable to the submission under review by the Department, the health insurer shall submit documentation that includes all of the following:

1. The impact of medical trend changes by major service categories;

2. The impact of utilization changes by major service categories;

3. The impact of cost-sharing changes by major service categories, including actuarial values;

4. The impact of geographic factors and variations;

5. The impact of changes to all plans within the single risk pool product;

6. The impact of reinsurance and risk adjustment payments and changes;

7. The impact of benefit changes;

8. The impact of changes in enrollee risk profile;

9. The impact of any overestimate or underestimate of medical trend for prior year periods related to the rate increase;

10. The impact of changes in reserve needs;

11. The impact of changes in administrative costs related to programs that improve health care quality;

12. The impact of changes in other administrative costs;

13. The impact of changes in applicable taxes, licensing or regulatory fees;

14. Medical loss ratio;

15. The health insurer's capital and surplus; and

16. Other relevant documentation at the discretion of the Director.

C. A health insurer shall submit all documentation required under subsection (A) or (B) at the same time that:

1. The health insurer submits the preliminary justification required under R20-6-2302, or

2. The health insurer submits any new preliminary justification required under R20-6-2304(2)(b) and (c).

Notes

Ariz. Admin. Code § R20-6-2305

New Section made by final rulemaking at 18 A.A.R. 2721, effective October 3, 2012 (Supp. 12-4). Amended by final rulemaking at 30 A.A.R. 3767, effective 2/3/2025.