Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES
Rule 120-2-98-.05 - Standards of Review
Current through Rules and Regulations filed through September 23, 2024
In addition to standards or criteria of review that are otherwise applicable to a rate increase subject to review under this regulation, the following standards will apply to the review of rates to the extent applicable to the filing under review:
(1) The impact of medical trend changes by major service categories;
(2) The impact of utilization changes by major service categories;
(3) The impact of cost-sharing changes by major service categories;
(4) The impact of benefit changes;
(5) The impact of changes in enrollee risk profile;
(6) The impact of any overestimate or underestimate of medical trend for prior year periods related to the rate increase;
(7) The impact of changes in reserve needs;
(8) The impact of changes in administrative costs related to programs that improve health care quality;
(9) The impact of changes in other administrative costs;
(10) The impact of changes in applicable taxes, licensing or regulatory fees;
(11) Medical loss ratio; and
(12) The health insurance issuer's capital and surplus.
O.C.G.A. Sections 33-2-9, 33-9-1et seq., 33-21-13, 33-21-18(a), 33-21-28.
