In addition to
the requirements of Section
, the following rate filings must
meet the requirements of this section, unless the Superintendent determines
that the requirement is not appropriate for a particular filing:
1. All individual health insurance rate
filings, except rate filings for policies subject to the ACA rating
2. Small group rate
filings subject to Title 24-A M.R.S.A. § 2808-B, except policies subject
to the ACA rating requirements;
Association groups as defined by Title 24-A M.R.S.A. § 2805-A and other
groups as defined by Title 24-A M.R.S.A. § 2808, except as to any employer
subgroups of the association group when:
The employer is a member of the group and provides coverage through the group
as a bona fide employee benefit; and
b. Either the employer is a large employer or
the employer is a small employer and the carrier's anticipated average number
of members in all small group health plans during the period for which the
rates will be in effect meets standards for full or partial credibility
pursuant to the ACA; and
4. Credit union groups as defined by Title
24-A M.R.S.A. § 2807-A.
B. Every policy, rider, or endorsement form
affecting benefits which is submitted for approval must be accompanied by a
rate filing or, if the form does not require a change in the premium, the
submission must include a complete explanation of the effect on the anticipated
loss ratio. The rate filing must include all rates, rating formulas, and
revisions. Rates must be filed with the form rather than separately.
C. If the filing is a rate revision, the
reason for the revision must be stated.
D. Individual rates must be filed separately
from group rates. Small group rates must be filed separately from individual or
large group rates. The filing must clearly identify the market to which the
filing applies. The filing must be received by the Bureau at least 60 days
before the implementation date unless the Superintendent waives this
requirement pursuant to Title 24-A M.R.S.A. § 2736(1) or §
2808-B(2-A)(A).Every effort will be made to process filings within 30 days. If
the Bureau requests additional information or finds rates not to be in
compliance, rates approved previously must continue to be used.
The filing must include sufficient
supporting information to demonstrate that the rates are not excessive,
inadequate, or unfairly discriminatory. Carriers are required to review their
experience no less frequently than annually and to file rate revisions, upward
or downward, as appropriate. Upward revisions must be filed in a timely manner
to avoid the necessity of large increases.
All PDF documents must be submitted in a searchable format, not
2. All PDF documents must
be unlocked so that information can be copied from the document.
3. All spreadsheets must be in Excel format
and include formulas. A PDF copy of each spreadsheet must also be included.
F. If any rates will be
automatically adjusted subsequent to the effective date of the filing based on
a trend factor or other factor, this must be clearly disclosed in the filing.
Automatic trend increases must be limited to one year from the effective date.
No automatic trend increases may be implemented one year or more after the
effective date of the filing unless a new filing is submitted and
In addition to the
general filing requirements for all filings, rate submissions subject to this
section must contain to the extent applicable for the type of filing:
morbidity basis for the form, including the source or sources used. Any
substantive adjustments from the source or earlier assumptions must be
explained. The morbidity assumed must be adequately justified by supporting
applicable, state the mortality basis and any substantive adjustments from
earlier assumptions must be explained.
Issue Age Range:Specify the
issue age range of the form and whether premiums are on an issue age, attained
age, or other basis.
Average Premium:Display the average annual premium per individual
policy or group certificate for both Maine and all states in which the form is
or was sold. If a rate adjustment is proposed, the filing must disclose the
average percentage increase a policyholder will experience as well as the
largest percentage increase that any in-force policy will receive. The average
increase must be determined by comparing the aggregate premium before and after
the increase (assuming no lapses) for all policies renewing during the period
during which the rates are intended to be in effect. The maximum increase is
the largest increase for an in-force policy, including changes due to trend,
aging, and changes in demographic, area, industry rating factors, but excluding
changes in the covered population under a group policy.
Assumptions:Provide the medical trend and any other trends used and the
assumptions used to calculate the trend(s).
Maine Experience on the Form
(Past and Future Anticipated): Consider experience solely within the State of
Maine in developing rates. However, if there is insufficient experience within
Maine upon which a rate can be based, the carrier may use nationwide
experience. In considering experience outside the State of Maine, as much
weight as possible must be given to Maine experience. If nationwide experience
is used, premiums must be adjusted to the Maine rate level and, where
appropriate, claims must be adjusted to Maine utilization and price levels. If
premiums incorporate area factors that adjust for variations in utilization and
price levels such that adjusting experience to Maine levels would result in the
same percentage adjustment to both premiums and claims, then neither adjustment
need be made. The carrier in its rate filing shall expressly show what
geographic experience it is using. Experience from inception for each calendar
year and, where appropriate, each policy year must be displayed, except that
for small group business only the past three years must be displayed, including
the following information :
(4) Paid claims
(5) Paid pure loss ratio
(6) Change in claim liability and
(7 ) Incurred
(8 ) Incurred pure loss
(9 ) Expected incurred
Active Life Reserves
For future years, columns (3), (7), and (8) must be
displayed. For periods where the actual claim runoff is complete, that data
must be displayed to replace (6). Past experience must be presented on both an
actual basis and a constant premium rate basis.
the same data as for paragraph 6 for all states in which the form is or was
History of Rate
Adjustments:List the approval dates and average percentage rate
adjustments for the form both nationwide and in Maine since inception of the
policy form, except that for small group business only data for the past three
years need be listed.
Renewability Clause:Identify the renewability classification of
Ratios:State the minimum pure loss ratio determined according to Section
7, 8, or 9, as applicable, and the anticipated future and lifetime pure loss
Classes:State all the attributes upon which the premium rates vary. If
the form is area-rated, a complete table of area factors for all states must be
Method:Provide a brief description of the market and the marketing
method. Specify whether the form is still being sold and whether the filing
applies only to new business, only to in-force business, or both, and the
Underwriting:Provide a description of the extent to which this product
will be medically underwritten, if any, and the expected impact by duration and
in total, on claim costs.
Active Life Reserves: If applicable, the filing must state whether
the policy includes active life reserves and describe the basis for these
Certification:Provide certification by a qualified actuary that to the
best of the actuary's knowledge and judgment, the entire rate filing is in
compliance with the applicable laws of the State of Maine and with the rules of
the Bureau of Insurance. "Qualified actuary," as used herein, means a member in
good standing of the American Academy of Actuaries.