02-031 C.M.R. ch. 940, § 12 - Review Pursuant to the ACA

Current through 2022-14, April 6, 2022

A. All rate filings that have been identified as "potentially unreasonable" in accordance with the ACA and are subject to Section 13 of this Rule must include Part II of the ACA Preliminary Justification for the rate increase, in addition to Parts I and III required by Section 13. Part II is a simple and brief narrative describing the data provided in Part I for any product(s) within the single risk pool which have rate increases subject to review, and the assumptions used to develop the rate increase, including an explanation of the most significant factors causing the rate increase.
A-1. All rate filings that have been identified as "potentially unreasonable" in accordance with the ACA and which relate to transitional coverage as defined in Section 4 must include the ACA Preliminary Justification, Part I rate increase summary (a form that summarizes the data used to determine the rate increase) and Part II (the written explanation of the rate increase described in Subsection A).
B. A rate increase will be determined to be unreasonable if it is excessive or unfairly discriminatory, or if the carrier provides data or documentation that is incomplete, inadequate, or otherwise does not provide a basis to determine whether the increase is reasonable, and fails to correct the deficiency within a reasonable time in response to a request by the Bureau.
C. Small group rates for credible blocks filed pursuant to Subsection 9(D) may be implemented regardless of whether they are determined to result in an unreasonable rate increase.
1. A carrier may request a preliminary determination of reasonableness and may modify the filing to avoid implementing an unreasonable rate increase.
2. A carrier requesting such a preliminary determination should specify the date by which the determination is needed and should submit the filing at least 60 days before the preliminary determination is needed. The Bureau may or may not be able to honor requests for a determination in less than 60 days.


02-031 C.M.R. ch. 940, § 12

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