211 CMR 41.06 - Content and Timing of Rate Filings

Current through Register 1466, April 1, 2022

(1) General Instructions.
(a) A separate Rate Filing must be submitted for each Closed Guaranteed Issue Health Plan, including separate filings for Standard Benefits Plan or Enhanced Benefits Plans and any Alternative Benefits Plan, and for each Closed Plan; provided that a Carrier with more than one Closed Plan may combine Rate Filings for its Closed Plans if the plans' benefits vary by no more than the following extent: any deductibles for the combined plans do not vary by more than $1,000; any coinsurance percentage amounts for the combined plans do not vary by more than 10%; and any copayments (excluding for emergency room visits) for the combined plans do not vary by more than $50; and, provided further, that a Rate Filing for a Closed Plan with outpatient prescription drug benefits may not be combined with a Rate Filing for a Closed Plan without outpatient prescription drug benefits, and a Rate Filing for a Closed Plan with medical/surgical and hospital benefits may not be combined with a Rate Filing for a Closed Plan with only hospital benefits. For each plan, Carriers also shall submit data and documentation reasonably necessary to substantiate all calculations and adjustments made. Carriers shall comply with all applicable filing fee requirements for each Rate Filing.
(b) A Carrier may establish a premium rate adjustment based upon the age of an insured individual, the age rate adjustment, which may range from 0.67 to 1.33. If a Carrier chooses to establish age rate adjustments, the premium charge to every individual enrolled in a Closed Guaranteed Issue Health Plan shall be subject to the applicable age rate adjustment.
(c) Carriers shall submit Rate Filings via SERFF no later than May 1st of each year.
(d) All Rate Filings must comply with the provisions of the rate and filing requirements of the Carrier's licensing statutes which are not inconsistent with M.G.L. c. 176M and 211 CMR 41.00.
(2) Closed Guaranteed Issue Health Plans. All Rate Filings for Closed Guaranteed Issue Health Plans must offer a minimum of four Rate Basis Type categories with one of these categories required to be for a single parent with more than one dependant and must contain at least the following information.
(a) A list and definition of each Rate Basis Type that the Carrier has established;
(b) The base premium rate to be charged for each Rate Basis Type;
(c) The adjustments to be applied to each Rate Basis Type's base premium rate based upon age, geographic area, premium payment mode or subsidization factor. For each Rate Basis Type, the Rate Filing must contain:
1. A list and definition of each age band for which adjustments will be made for each Rate Basis Type;
2. A list of each geographic region for which area adjustments are based for each Rate Basis Type in accordance with 211 CMR 41.03;
3. A list and description of each premium payment mode for which adjustments will be made for each Rate Basis Type, and the premium refund policy, if any, for each; and
4. A list and description of each subsidization factor to be applied to the plan, including the specific eligibility criteria that will be used by the Carrier for each subsidization factor.
(d) A complete set of proposed rate schedules, showing the proposed rates for each eligible individual based upon age, geographic area, premium payment mode, subsidization factor, where applicable, and Rate Basis Type;
(e) The Composite Rate, including a detailed explanation of the method by which the Carrier determined the composite rate, including all calculations and data used for the projected distribution of covered lives by age, geographic area and premium payment mode for each Rate Basis Type and developed in the manner prescribed by 211 CMR 41.98;
(f) For Enhanced Benefits Plans, a list and description of each additional benefit or lower cost-sharing requirement included in the plan and the proportion of the proposed premium, if any, associated with each enhancement;
(g) For Alternative Benefits Plans:
1. A list and description of each lower benefit or higher cost-sharing requirement than that is provided in the Carrier's Standard Benefits Plan or Enhanced Benefits Plan, as well as details regarding how the Alternative Benefits Plan's base premium rate differs from that of the Standard Benefits Plan's or Enhanced Benefits Plan's rates for each difference in benefits or cost-sharing requirement. The Rate Filing also should include a benefit level rate adjustment that shall represent the actuarial value of the benefit level of the Alternative Benefits Plan as compared to the benefit level of the Standard Benefits Plan or Enhanced Benefits Plan offered by the Carrier. The premium charged to every individual enrolled in an Alternative Benefits Plan shall be subject to the applicable benefit level rate adjustment and there shall be no benefit level rate adjustment to a Standard Benefits Plan.
2. An Actuarial Opinion and Memorandum signed by a member of the American Academy of Actuaries. The certification shall indicate that the Alternative Benefits Plan's benefit level rate adjustment was developed assuming no difference in the expected costs and utilization for those in the Alternative Benefits Plan as compared with those in the Standard Benefits Plan or Enhanced Benefits Plan. The opinion shall also provide sufficient documentation to support the benefit level rate adjustment.
(h) The Adjusted Composite Rate for each Closed Guaranteed Issue Health Plan, developed in the manner prescribed by 211 CMR 41.05 and 41.98;
(i) For Carriers that base payments on usual and customary charges for non-contracting providers for Guaranteed Issue Medical Plans and for the out-of-network benefits of Guaranteed Issue Preferred Provider Plans, an actuarial opinion certifying that the Carrier has used a methodology to determine its usual and customary charges that results in usual and customary charges that are, in the aggregate, at least comparable to, and not lower than, the 80th percentile of charges based on Health Insurance Association of America data that are not more than 18 months old, as well as a description of the methodology;
(j) An Actuarial Opinion and Memorandum certifying that the rates have been developed in compliance with M.G.L. c. 176M, ยง 4, including the specified rate bands and multipliers, and that the proposed rates are reasonable in relation to the benefits provided. The Actuarial Opinion and Memorandum must include an explanation of the basis for the actuary's opinions, with consideration of the actuarial basis for each age, area, premium payment mode and enhancement or alternative benefit in light of the value of benefits and the effects on utilization;
(k) The actual loss ratio for the previous year and the projected loss ratios for the present year and the year for which the rate is being filed;
(l) A comparison of current and proposed rates which shows premium cost components, including expenses, hospital inpatient costs, outpatient costs, the cost of prescription drugs administered on an outpatient basis, and the cost of other medical services, each stated as a percentage of premium;
(m) The name, address and telephone and facsimile transmission numbers of the person responsible for the Rate Filing, if different from the actuary who signed the Actuarial Opinion and Memorandum required in 211 CMR 41.06(2)(i);
(n) A copy of the Carrier's most recent statutory annual report, unless already on file with the Division; and
(o) A certification by a corporate officer stating when the Closed Guaranteed Issue Health Plan's policy form was last filed with the Division, and stating that the policy form has not changed since it was previously filed. If the policy form must be modified to comply with Massachusetts statutory changes, including new mandated benefits or changes to the Standard Benefits Plans, the filing must include revised policy forms, or policy form riders or endorsements necessary to respond to the statutory changes.
(3) Closed Plans. All Rate Filings for Closed Plans must contain at least the following information.
(a) A list and definition of each Rate Basis Type which the Carrier has established;
(b) The base premium rate to be charged for each Rate Basis Type;
(c) The adjustments to be applied to each Rate Basis Type's base premium rate based upon age, geographic area, premium payment mode, health benefit, or other rating factor. For each Rate Basis Type, the Rate Filing must contain:
1. A list and definition of each age band for which adjustments are made;
2. A list of each geographic area on which adjustments are based;
3. A list and description of each premium payment mode for which adjustments are made; and
4. A list and definition of any other rating factor to be charged.
(d) A complete set of proposed rate schedules for each plan, showing proposed rates applicable to each Eligible Individual based upon age, geographic area, premium payment mode, rate basis type, health benefit or any other rating factor;
(e) An Actuarial Opinion and Memorandum certifying that the rates for each plan have been developed in compliance with the requirement that no Carrier shall add any new rating factor to the rating methodology other than that which was applicable to its Closed Plan as of August 15, 1996;
(f) For each plan, the actual loss ratio for the previous year and the projected loss ratios for the present year and the year for which the rate is being filed;
(g) A copy of the Carrier's most recent statutory annual report unless already on file with the Division; and
(h) A certification by a corporate officer stating when the Closed Plan's policy form was last filed with the Division, and stating that the policy form has not changed since it was previously filed. If the policy form must be modified to comply with Massachusetts statutory changes, including new mandated benefits, the filing must include revised policy forms, or policy form riders or endorsements necessary to respond to the statutory changes.

Notes

211 CMR 41.06

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