044-49 Wyo. Code R. §§ 49-6 - Restrictions Relating to Premium Rates

(a) A small employer carrier shall develop a separate rate manual for each class of business. Base premium rates and new business premium rates charged to small employers by the small employer carrier shall be computed solely from the applicable rate manual developed pursuant to this subsection. To the extent that a portion of the premium rates charged by a small employer carrier is based on the carrier's discretion, the manual shall specify the criteria and factors considered by the carrier in exercising such discretion. The carrier shall also provide the Commissioner, upon request, the rate manual and any additional information or documentation specified in this Section.

(i) A small employer carrier that modifies the rating method used in the rate manual for a class of business shall maintain with the rate manual for a period of six (6) years information and documentation containing the following:

(A) The reasons the change in rating method is being modified;

(B) A complete description of each of the proposed modifications to the rating method;

(C) A description of how the change in rating method would affect the premium rates currently charged to small employers in the class of business, including an estimate from a qualified actuary of the number of groups or individuals (and a description of the types of groups or individuals) whose premium rates may change by more than ten percent (10%) due to the proposed change in rating method (not generally including increases in premium rates applicable to all small employers in a health benefit plan);

(D) A certification from a qualified actuary that the new rating method would be based on objective and credible data and would be actuarially sound and appropriate; and

(E) A certification from a qualified actuary that the proposed change in rating method would not produce premium rates for small employers that would be in violation of W.S. § 26-19-304.

(ii) For the purpose of this section a change in rating method shall mean:

(A) A change in the number of case characteristics used by a small employer carrier to determine premium rates for health benefit plans in a class of business;

(B) A change in the manner or procedures by which insureds are assigned into categories for the purpose of applying a case characteristic to determine premium rates for health benefit plans in a class of business;

(C) A change in the method of allocating expenses among health benefit plans in a class of business; or

(D) A change in a rating factor with respect to any case characteristic if the change would produce a change in premium for any small employer that exceeds ten percent (10%). A change in a rating factor shall mean the cumulative change with respect to such factor considered over a twelve (12) month period. If a small employer carrier changes rating factors with respect to more than one case characteristic in a twelve (12) month period, the carrier shall consider the cumulative effect of all such changes in applying the ten percent (10%) test.

(b) The rate manual developed pursuant to subsection (a) shall specify the case characteristics and rate factors to be applied by the small employer carrier in establishing premium rates for the class of business.

(c) A small employer carrier shall use the same case characteristics in establishing premium rates for each health benefit plan in a class of business and shall apply them in the same manner in establishing premium rates for each health benefit plan. Case characteristics shall be applied without regard to the risk characteristics of a small employer.

(d) The rate manual developed pursuant to subsection (a) shall clearly illustrate the relationship among the base premium rates charged for each health benefit plan in the class of business. If the new business premium rate is different than the base premium rate for a health benefit plan, the rate manual shall illustrate the difference.

(e) Differences among base premium rates for health benefit plans shall be based solely on the reasonable and objective differences in the design and benefits of the health benefit plans and shall not be based in any way on the actual or expected health status or claims experience of the small employer groups that choose or are expected to choose a particular health benefit plan. A small employer carrier shall apply case characteristics and rate factors within a class of business in a manner that assures that premium differences among health benefit plans for identical small employer groups vary only due to reasonable and objective differences in the design and benefits of the health benefit plans and are not due to the actual or expected health status or claims experience of the small employer groups that choose or are expected to choose a particular health benefit plan.

(f) Except as provided in subparagraph (g), a premium charged to a small employer for a health benefit plan shall not include a separate application fee, underwriting fee, or any other separate fee or charge.

(g) A carrier may charge a separate fee with respect to a health benefit plan (but only one fee with respect to such plan) provided the fee is no more than five dollars ($5.00) per month per employee and is applied in a uniform manner to each health benefit plan in a class of business, with such fee being included in determining the carrier's compliance with W.S. § 26-19-304.

(h) A small employer carrier shall allocate administrative expenses to the basic and standard health benefit plans on no less favorable of a basis than expenses are allocated to other health benefit plans in the class of business. The rate manual developed pursuant to subsection (a) shall describe the method of allocating administrative expenses to the health benefit plans in the class of business for which the manual was developed.

(i) Each rate manual, updates, and changes developed pursuant to subsection (a) shall be maintained by the carrier for a period of six (6) years.

(j) The rate manual and rating practices of a small employer carrier shall comply with any guidelines issued by the Commissioner.

(k) If group size is used as a case characteristic, the highest rate factor associated with a group size shall not exceed the lowest rate factor by more than 20 percent (20%).

(l) A small employer carrier shall revise its rate manual each rating period to reflect changes in base premium rates and changes in new business premium rates.

(m) A small employer carrier shall keep on file for a period of at least six (6) years the calculations used to determine the change in base premium rates and new business premium rates for each health benefit plan for each rating period.

(n) Changes in premium rates for a small employer shall be subject to the provisions in W.S. § 26-19-304.

Notes

044-49 Wyo. Code R. §§ 49-6

Amended, Eff. 10/13/2015.