211 CMR 41.05 - Calculation of Adjusted Composite Rate

Current through Register 1466, April 1, 2022

(1) To derive the Adjusted Composite Rate for each Closed Guaranteed Issue Health Plan, Carriers shall adjust the Composite Rate to account for differences in premiums among Carriers that are the result of geographic differences in the cost of health care, the average age of eligible individuals enrolled in a Carrier's Closed Guaranteed Issue Health Plan, and differences in benefit levels as permitted by M.G.L. c. 176M, § 2(c)(4) or M.G.L. c. 176M, § 2(d).
(2) Worksheet. A Carrier shall use the worksheet contained in 211 CMR 41.98: Appendix A to calculate the Adjusted Composite Rate for each type of Closed Guaranteed Issue Health Plan it offers. For all noted adjustments, Carriers shall submit documentation reasonably necessary to substantiate the adjustments made, including:
(a) A specific explanation, and all calculations, of the method by which the Adjusted Composite Rate was determined;
(b) A list of all adjustments based upon age, geographic area, premium payment mode, and enhancements or alternative benefits; and
(c) An explanation of the actuarial value and actuarial basis for adjustments made for each age band, geographic area, premium payment mode, and enhancements, or alternative benefits.


211 CMR 41.05

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