28 Tex. Admin. Code § 3.502 - Definitions
For purposes of this subchapter, the following terms have the meanings indicated, except where the context clearly indicates otherwise:
(1) Actuarial value
(AV)--As defined in
45
CFR §
156.20, concerning
Definitions.
(2) Cost-sharing
reductions (CSRs)--As defined in
45
CFR §
155.20, concerning
Definitions.
(3) Essential health
benefits (EHBs)--Health benefits contained in the applicable "essential health
benefits package" as that term is defined in
45
CFR §
156.20.
(4) Federal medical loss ratio standard--The
applicable medical loss ratio standard for the market segment involved,
determined under subpart B of 45 CFR part 158, concerning Issuer Use of Premium
Revenue: Reporting and Rebate Requirements.
(5) HHS--The U.S. Department of Health and
Human Services.
(6) Issuer--An
insurance company or health maintenance organization that issues a plan that is
subject to Insurance Code Chapter 1698, concerning Rates for Certain
Coverage.
(7) Index rate--A rate
based on the total combined claims costs for providing essential health
benefits within the single risk pool of the applicable market.
(8) Plan--As defined in
45
CFR §
144.103, concerning
Definitions.
(9) Product--As
defined in
45
CFR §
154.102, concerning
Definitions.
(10) Qualified
actuary--An actuary who is certified by the American Academy of Actuaries to
meet the U.S. Qualification Standards.
(11) Single risk pool--With respect to a
particular issuer and for the purposes of considering claims experience and
developing an index rate, the grouping of all members enrolled in individual
market plans or small group market plans that are subject to this chapter,
consistent with
45 CFR §
156.80,
concerning Single Risk Pool.
(12)
Unified Rate Review Template (URRT)--A spreadsheet that comprises Part I of the
rate filing justification, as described in
45 CFR §
154.215, concerning Submission of Rate Filing
Justification.
Notes
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