02-031 C.M.R. ch. 940, § 5 - General Rate Submission Requirements

Current through 2022-14, April 6, 2022

A. A rate filing must be submitted whenever a new policy, rider, or endorsement form that affects benefits is submitted for approval and whenever there is a change in the rates applicable to a previously approved form.

B. Filings must be filed electronically, using the System for Electronic Rate and Form Filing (SERFF).

1. Filings must also include a completed "Rate Filing Review Requirements Checklist," available on the Bureau's website.

2. The Superintendent may request additional information as necessary.

3. Group rates are submitted on a "file and use" basis for informational purposes, with the exception of small group rates subject to Title 24-A M.R.S.A. § 2808-B where the anticipated average number of members during the period for which the rates will be in effect does not meet standards for full or partial credibility pursuant to the ACA, in which case the rates must be filed for prior approval.

4. Rates for individual health plans subject to Title 24-A M.R.S.A. § 2736-C are submitted on a "file and use" basis for informational purposes if the carrier has elected the guaranteed loss ratio option pursuant to Subsection 8(H) and rate review is not required pursuant to the ACA.

C. To assist the Bureau, every rate submission must contain the information and documents set forth in this subsection to the extent applicable based on the type of filing. For policies subject to ACA rating requirements, inclusion of the ACA Rate Filing Justification Part I, the unified rate review template, and Part III, the actuarial memorandum, will satisfy paragraphs 1 through 5 below.

1. Carrier Information:Include the name and address of the carrier. The name, title, direct phone number, and email address of the person responsible for the filing must also be noted.

2. Scope and Purpose of Filing:Specify whether this is a new form filing, a rate revision, or a justification of an existing rate.

3. Description of Benefits:Include a copy of the summary of coverage and explanation of benefits provided to consumers in accordance with the ACA, if applicable, for each policy form. Otherwise, include a brief description of the benefits provided by the policy, including any attached riders or endorsements within the scope of the rate submission.

4. In-Force Business:Include policy count and annualized premium of Maine policyholders or certificate holders who will be affected by the proposed rate revision. For group business, include the number of covered persons.

5. Proposed Effective Date:State the proposed effective date and method of the proposed rate revision implementation (e.g., next anniversary or next premium due date).

6. Confidentiality

a. Filings for all individual health insurance and for small group health plans subject to Title 24-A M.R.S.A. § 2808-B and all supporting information are public records except that:

(i) Protected health information required to be kept confidential by state or federal statute must be kept confidential; and

(ii) Descriptions of the amount and terms or conditions or reimbursement in a contract between an insurer and a provider or other third party may be kept confidential.

Any confidential information should be clearly identified as described in the confidentiality protocol available on the Bureau of Insurance website.

b. Filings for group health insurance other than small group health plans subject to Title 24-A M.R.S.A. § 2808-B may be prepared in a manner that protects the confidentially of information that is confidential under Maine law by following the confidentiality protocol available on the Bureau of Insurance website. Carriers are encouraged to minimize the amount of information for which confidentiality is requested.

Notes

02-031 C.M.R. ch. 940, § 5