N.H. Admin. Code § Ins 4102.03 - Definitions

For the purposes of this part:

(a) "Actuarial certification" means a written statement signed by a member of the American Academy of Actuaries;

(b) "Actuarial memorandum" means the document describing the basis on which rates were determined and that includes other supporting documentation as required;

(c) "Anticipated loss ratio" means the calculation of the medical loss ratio over a period that is at least as great as the anticipated policy lifetime that does not exceed 20 years;

(d) "Case characteristics" means demographic or other relevant characteristics considered by the individual carrier in the determination of premium rates for an individual;

(e) "Durational medical loss ratio" means the medical loss ratio calculated for a specified duration not to exceed 12 months;

(f) "Earned premium" means premium revenue pursuant to 45 CFR Part 158.130;

(g) "Earned premium adjustments" means federal and state taxes and licensing and regulatory fees pursuant to 45 CFR Part 158.161(a) and 158.162(a)(1) and (b)(1);

(h) "Health coverage" means "health coverage" as defined in RSA 420-G:2, IX;

(i) "Incurred claims" means reimbursements for clinical services provided to enrollees, pursuant to 45 CFR Part 158.140;

(j) "Medical loss ratio" means medical loss ratio defined in 45 CFR Part 158.221(a);

(k) "Member" means "covered person" as defined in Ins 4101.04(c);

(l) "Premium" means the total amount due from a policyholder to an individual carrier for the provision of health coverage;

(m) "Premium rate" means an amount per covered person used to calculate premium;

(n) "Quality improvement expenses" means amounts expended for activities that improve health care quality pursuant to 45 CFR 158.150 and 45 CFR 158.151;

(o) "Tier" means a category of enrollment to which enrolled individuals can elect coverage, and includes at a minimum, single person, couple, and family tiers;

Notes

N.H. Admin. Code § Ins 4102.03

#9690, eff 4-9-10; ss by #9938, eff 6-10-11; ss by #10212, eff 11-1-12

The amended version of this section by New Hampshire Register Volume 39, Number 24, eff.6/10/2019 is not yet available.