211 CMR 41.10 - Review of Policy Forms and Rate Filings and Notification to Carriers

(1) Policy Forms. The Commissioner shall notify a Carrier if he or she determines that the policy form filing submitted pursuant to 211 CMR 41.09 does not comply with applicable Massachusetts laws and regulations or otherwise fails to comply with M.G.L. c. 176M or 211 CMR 41.09. Upon such notice, a Carrier shall amend and resubmit its policy form filing for review within the time period specified by the Commissioner.

(2) Rate Filings for Closed Guaranteed Issue Health Plans.

(a) The Commissioner shall notify a Carrier if he or she determines that the Rate Filing does not comply with 211 CMR 41.00, contains discrepancies or inaccuracies, or otherwise is incomplete. Upon such notice, a Carrier shall amend and resubmit its Rate Filing within the time period specified by the Commissioner.

(b) After the Commissioner has computed an Average Adjusted Composite Rate for each type of Closed Guaranteed Issue Health Plan, and has calculated the standard deviation for the submitted Adjusted Composite Rates, the Average Adjusted Composite Rate and Standard Deviation will be final and will not be changed if any Carrier's rates are modified as a result of further review by the Commissioner or a Proceeding.

(c) The Commissioner shall, no later than June 15^th of each year, issue to a Carrier his or her determination of whether the Carrier's Rate Filing is subject to further review. The Rate Filing will be subject to further review if the Commissioner determines that the Adjusted Composite Rate filed by a Carrier exceeds the Average Adjusted Composite Rate for that type of Closed Guaranteed Issue Health Plan by more than two Standard Deviations and the proposed Adjusted Composite Rate also exceeds 110% of the Carrier's current Adjusted Composite Rate for the plan.

(d) If the Commissioner issues a notice to a Carrier by June 15^th that its Rate Filing is not subject to further review, the Carrier shall implement the filed rates the following December 1^st.

(3) Rate Filings for Closed Plans. The Commissioner shall notify the Carrier if its Rate Filing does not comply with 211 CMR 41.00, contains discrepancies or inaccuracies, or otherwise is incomplete. Upon such notice, a Carrier shall amend and resubmit its Rate Filing within the time period specified by the Commissioner. The Commissioner's review of Rate Filings for Closed Plans will proceed in accordance with the applicable provisions of the Carrier's licensing statutes.

Notes

211 CMR 41.10