N.H. Admin. Code § Ins 4103.07 - Rate Filing Standards
(a) Carriers shall
calculate a market rate in accordance with the following:
(1) The calculation shall reflect the
carrier's experience for all the products it sells and maintains in the small
group health insurance market;
(2)
Plan relativity factors that are used to modify the carrier's experience to a
common market rate shall be the same factors that were used to calculate the
health coverage plan rates during the experience period;
(3) The market rate shall be normalized for
the average plan relativity factor; and
(4) Other assumptions used by the carrier in
the calculation of the market rate shall be specified.
(b) The carrier shall calculate health
coverage plan rates for the coverages it will offer from the market rate. The
carrier shall provide plan relativity factors used to calculate the health
coverage plan rates from the market rate. Any changes to the health coverage
plan rates from the previously approved set of plan relativity factors shall be
highlighted and the basis for the same shall be documented.
(c) Carriers shall calculate premium rates
for each small employer from the health coverage plan rate through the
application of factors for allowable case characteristics as follows:
(1) Carriers electing to use age as an
allowable case characteristic shall comply with the following:
a. Tabulations by age shall be made using the
age brackets delineated in
RSA 420-G:4, I.
(e)(2); and
b. Acceptable
tabulation methods shall include:
1. Actual
enrollment and ages of all covered persons;
2. Actual enrollment, ages of all enrolled
employees and the tier to which they enrolled;
3. Estimated enrollment and ages of all
covered persons; and
4. Estimated
enrollment, ages of all enrolled persons and the tier to which they are assumed
to enroll;
(2) Carriers electing to use group size as an
allowable case characteristic shall comply with the following:
a. Variations in group size shall be based on
the number of enrolled employees in all of the plans offered by the small
employer carrier to the small employer 's employees; and
b. Carriers may estimate the number of
enrolled employees as long as the estimation methods used are uniform for all
small employers;
(3)
Carriers electing to use the type of industry in which the small employer is
engaged shall apply industry variations uniformly for all small employers;
and
(4) The total variation
attributable to allowable case characteristics shall be subject to the
following standards:
a. The ratio of the
following calculation shall not exceed 3.5:
1.
The largest premium rate obtainable from the application of the allowable case
characteristics for any small employer group having no covered persons or
enrolled employees less than 19 years old; and
2. The smallest premium rate obtainable from
the application of the allowable case characteristics for any small employer
group having no covered persons or enrolled employees less than 19 years
old.
(d) All submissions shall:
(1) Include an actuarial certification and an
actuarial memorandum , consisting of the sections prescribed herein;
(2) Be provided as electronic documents, in
formats as prescribed herein; and
(3) Be attached to the SERFF filing under the
supporting documentation tab with the components prescribed
herein.
(e) The actuarial
memorandum shall include a component labeled "Public Information" that contains
a Microsoft Excel or compatible workbook that includes:
(1) A worksheet named "Cover Sheet" that
includes the following information:
a.
Contact information;
b. A statement
indicating that the filing includes all of the carriers small group health
insurance rates, or an explanation as to why it does not; and
c. A statement indicating whether the carrier
utilizes list billing, and if so, a description of the groups being list
billed;
(2) A worksheet
named "Proposed Rate Change and Enrollment by Health Coverage Plan" that
includes the following information for each health coverage plan:
a. Plan codes or suitable plan
identifier;
b. The number of
expected or enrolled members, subscribers and groups;
c. The number of expected or enrolled
members, subscribers and groups that will be impacted by the proposed rate
change; and
d. The proposed health
coverage plan rate;
(3) A
worksheet named "Plan Design and Plan Relativities" that includes the following
information:
a. Carrier plan code or
name;
b. PCP office visit
copay;
c. Specialist office visit
copay;
d. Emergency department
copay;
e. Outpatient surgery
copay;
f. In-network single
deductible;
g. In-network
coinsurance;
h. In-network single
out-of-pocket maximum;
i.
Indication if the deductible applies to all medical services;
j. Services that deductible does not apply
to;
k. Indication if the deductible
applies to pharmacy services;
l.
Indication if preventive services are covered in full;
m. Indication if the health coverage plan
covers mental health and substance services;
n. Indication if the health coverage plan has
a tiered network component;
o.
Retail pharmacy single deductible generic;
p. Retail pharmacy single deductible brand
formulary;
q. Retail pharmacy
single deductible brand non-formulary;
r. Retail pharmacy copay generic;
s. Retail pharmacy copay brand
formulary;
t. Retail pharmacy copay
brand non-formulary;
u. Plan
relativity factors for proposed rates;
v. Policy form number;
w. Indication if the health coverage plan is
open or closed;
x. Indication if
the health coverage plan is grandfathered or non-grandfathered by federal
definition;
y. Renewability of the
health coverage plan;
z. General
marketing method;
aa. Issue age
limits; and
ab. Indication if the
health coverage plan is new;
(4) A worksheet named "Experience Used in the
Rate Development" that includes a brief description of the source for the
experience data and PMPM claims information for:
a. Inpatient facility;
b. Outpatient facility;
c. Professional services;
d. Prescription drugs;
e. Capitation arrangements;
f. Other provider payments; and
g. Other;
(5) A worksheet named "Administrative
Charges" that includes administrative charges as PMPM amounts;
(6) A worksheet named "Retention Charges"
that includes information for retention charges segmented by:
a. Administrative costs;
b. Investment income credits;
c. Contributions to surplus or profit;
and
d. Other;
(7) A worksheet named "Illustrative Rates"
that delineates the final rate for 2 hypothetical groups;
(8) A worksheet named "Summary of Rating
Factors" that provides information regarding the carrier's utilization of
allowable rating factors;
(9) A
worksheet named "Health Coverage Plan Rate PMPM Development for Standard Health
Coverage Plan" that delineates how the health coverage plan rate is calculated
for prescribed standard plans including the following information:
a. PMPM experience data;
b. Annual trend factor;
c. Months of trend;
d. Trend adjustments; and
e. PMPM retention; and
(10) A worksheet named "Medical Loss Ratio
Exhibit Small Group Market" that includes documentation regarding the
calculation of the anticipated loss ratio with the following information:
a. Member months;
b. Incurred claims ;
c. Earned premium ;
d. Quality improvement expenses ;
and
e. Earned premium
adjustments .
(f) The actuarial memorandum shall include a
component on the supporting documentation tab labeled "Supporting Public
Information" with an attached PDF document that includes:
(1) An exhibit titled "Discussion of
Credibility" that includes references to the sources for experience data,
limitation on using plan specific experience and any explanation for experience
adjustments;
(2) An exhibit titled
"Illustrative Rates" that delineates the rate development for 2 hypothetical
groups;
(3) An exhibit titled
"Rating Factors" that includes rate factor tables for each rating
factor;
(4) An exhibit titled
"Expected Distribution of Rating Factors" that includes information delineating
the expected distribution of membership by allowable rating factors with tier
and conversion factors; and
(5) An
exhibit titled "Description of Methodology for the Projected Medical Loss
Ratio " that includes a discussion of data sources and pricing assumptions used
to calculate the anticipated loss ratio .
(g) The actuarial memorandum shall include a
component on the supporting documentation tab labeled "Confidential
Information" that contains a Microsoft Excel or compatible workbook that
includes a worksheet named "Detail on Final Trend Assumptions" with trend
assumptions segmented by:
(1) Service
categories, including:
a. Inpatient facility;
b. Outpatient facility;
c. Professional services;
d. Prescription drugs;
e. Other; and
(2) Changes in:
a. Unit cost; and
b. Utilization.
(h) The actuarial memorandum shall
include a component on the supporting documentation tab labeled "Supporting
Confidential Information" with an attached PDF document that includes:
(1) An exhibit titled "Description of Trend
Development" that includes an explanation of the process used to develop trend
assumptions; and
(2) An exhibit
titled "Supporting Schedules for Trend Development" that includes documentation
and other data to support the trend assumptions.
(i) Actuarial memoranda for rate revisions
shall modify the worksheets required above as follows:
(1) The worksheet named "Cover Sheet" shall
include the following additional information:
a. A statement certifying that there have
been no changes to rating methodology since the most recently approved filing
or a brief description of any such proposed changes; and
b. A statement certifying that there have
been no benefit changes to any of the plans for which rates are being revised
or a description of those benefit changes;
(2) The worksheet named "Proposed Rate Change
and Enrollment by Health Coverage Plan" shall include the following additional
information:
a. PMPM health coverage plan rate
in effect 12 months prior to the proposed rate effective date; and
b. PMPM health coverage plan from the most
recently approved filing;
(3) The worksheet named "Plan Design and Plan
Relativities" shall include:
a. Plan
relativities for coverage in effect on the rate effective date one year prior
to the rate filing effective date; and
b. Supporting documentation for plan
relativity factor changes that exceed 5%;
(4) The worksheet named "Detail Final Trend
Assumptions" shall include the total annualized trend assumption from the most
recently approved rate filing;
(5)
The worksheet named "Administrative Charges" shall include:
a. The administrative charges used for
coverages in effect on the rate effective date one year prior to the rate
filing effective date; and
b. The
administrative charges from the carrier's most recently approved
filing;
(6) The
worksheet named "Retention Charges" shall include:
a. The retention charges used for coverages
in effect on the rate effective date one year prior to the rate filing
effective date; and
b. The
retention charges from the carrier's most recently approved filing;
(7) The worksheet named "Summary
of Rating Factors" shall include an indication as to which of the rating
factors have changed since the most recently approved rate filing;
(8) The worksheet named "Health Coverage Plan
Rate PMPM Development for Standard Health Coverage " shall include:
a. The standard health coverage plan rates,
PMPM, for coverages in effect on the rate effective date one year prior to the
rate filing effective date; and
b.
The standard health plan coverage rates, PMPM, which were approved in the
carrier's most recently approved filing; and
(9) The worksheet named "Medical Loss Ratio
Exhibit Small Group Market" shall include the historical medical loss ratio for
the 3 complete calendar years prior to the rate effective date.
(j) Actuarial memoranda for rate
revisions shall include a component titled "Additional Required Public
Information for Rate Revisions" that contains a Microsoft Excel or compatible
workbook with the following:
(1) A worksheet
named "History of Rate Changes" that summarizes rate filings the carrier made
over the prior 3 years including:
a. The rate
effective date;
b. The average,
annual proposed rate change; and
c.
The average, annual approved rate change;
(2) A worksheet named "Distribution of Rate
Changes" that includes the number of enrolled members, subscribers and groups
that will be impacted by the proposed change segmented by the anticipated rate
change;
(3) A worksheet named
"Components of Average Proposed Rate Change" that includes the average rate
change attributable to rate changes in:
a.
Utilization;
b. Unit
costs;
c. Retention;
d. Benefit changes required by law;
e. Other benefit changes;
f. Over or under statement of prior rates;
and
g. Other.
(k) The actuarial memorandum for
rate revisions shall include a component on the supporting documentation tab
titled "Supporting Documentation for the Additional Required Public Information
for Rate Revisions" with a PDF document titled "Description of Rating Factors"
that includes supporting documentation for any proposed changes to the rating
factors.
(l) Carriers shall submit
a complete filing, at least annually, that includes all of the documentation
required for rate revisions even if no changes in rates are being proposed to
demonstrate that the continued use of the previously approved rates is
appropriate.
(m) All submissions
shall include an actuarial certification provided as a PDF document attached to
the supporting documentation tab under the public information component with
the following statements:
(1) A statement
indicating that the filing conforms to generally accepted actuarial
principals;
(2) A statement that
the entire filing is in compliance with all applicable laws and
rules;
(3) A statement that the
premiums are not inadequate, excessive, unfairly discriminatory, or
unreasonable in relation to the benefits;
(4) A statement that variations in health
coverage plan rates:
a. Shall not exceed the
maximum possible difference in benefits unless they are based on the following:
1. Expected utilization differences
attributable to plan design;
2.
Expected administrative cost differences attributable to plan design;
and
3. Provider reimbursement
variances attributable to plan design;
b. Do not vary based on the health
status/morbidity or other demographics of the population electing the varying
plans;
(5) A statement
indicating that premium rates are calculated from health coverage plan rates
and that premium rates vary from health coverage plan rates using only
allowable rating factors;
(6) A
statement that benefits are neither excluded nor vary by any of the allowable
rating factors; and
(7) A statement
indicating that the health plan coverages for which rates are being filed are
being actively marketed and are available to both new issues and renewing
policyholders.
(n)
Carriers shall make an annual filing for rates. Carriers shall file rates each
year on or before the uniform filing date established by the department,
consistent with annual guidance from the Center for Medicare and Medicaid
Services ("CMS"), for the coming calendar year. For rates subject to 45 CFR
Part 154, carriers shall, in addition to filing with the department, make all
filings required with CMS under federal regulations. Final approved rates for
all small group market filings shall be available for public review no later
than the start of the annual open enrollment period set by the U.S. Department
of Health and Human Services pursuant to 42 U.S.C. 1803 l(c)(6)(B).
(o) In addition to the required annual rate
filing, carriers may make interim filings no more than quarterly. Rate
effective dates shall begin on the first day of each quarter. Rates for interim
quarterly filings shall be available for public review on the rate effective
date.
(p) Upon issuance or renewal
of a policy, the rates for that policy shall be guaranteed to the policyholder,
and may not change, for 12 months from issue or renewal.
(q) In accordance with
RSA 91-A:5, IV, the
department shall maintain the confidentiality of the commercial and proprietary
trend assumptions and supporting documentation that is required to be submitted
under
Ins 4103.07(g) and
(h).
Notes
#9690, eff 4-9-10; ss by #9938, eff 6-10-11; ss by #10212, eff 11-1-12
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