Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m
Section 41.06 - Content and Timing of Rate Filings

(a) A separate Rate Filing must be submitted for each Closed Guaranteed Issue Health Plan, including separate filings for Standard Benefits Plan or Enhanced Benefits Plans and any Alternative Benefits Plan, and for each Closed Plan; provided that a Carrier with more than one Closed Plan may combine Rate Filings for its Closed Plans if the plans' benefits vary by no more than the following extent: any deductibles for the combined plans do not vary by more than $1,000; any coinsurance percentage amounts for the combined plans do not vary by more than 10%; and any copayments (excluding for emergency room visits) for the combined plans do not vary by more than $50; and, provided further, that a Rate Filing for a Closed Plan with outpatient prescription drug benefits may not be combined with a Rate Filing for a Closed Plan without outpatient prescription drug benefits, and a Rate Filing for a Closed Plan with medical/surgical and hospital benefits may not be combined with a Rate Filing for a Closed Plan with only hospital benefits. For each plan, Carriers also shall submit data and documentation reasonably necessary to substantiate all calculations and adjustments made. Carriers shall comply with all applicable filing fee requirements for each Rate Filing.

(b) A Carrier may establish a premium rate adjustment based upon the age of an insured individual, the age rate adjustment, which may range from 0.67 to 1.33. If a Carrier chooses to establish age rate adjustments, the premium charge to every individual enrolled in a Closed Guaranteed Issue Health Plan shall be subject to the applicable age rate adjustment.

(c) Carriers shall submit Rate Filings via SERFF no later than May 1st of each year.

(d) All Rate Filings must comply with the provisions of the rate and filing requirements of the Carrier's licensing statutes which are not inconsistent with M.G.L. c. 176M and 211 CMR 41.00.

(a) A list and definition of each Rate Basis Type that the Carrier has established;

(b) The base premium rate to be charged for each Rate Basis Type;

(c) The adjustments to be applied to each Rate Basis Type's base premium rate based upon age, geographic area, premium payment mode or subsidization factor. For each Rate Basis Type, the Rate Filing must contain:

(d) A complete set of proposed rate schedules, showing the proposed rates for each eligible individual based upon age, geographic area, premium payment mode, subsidization factor, where applicable, and Rate Basis Type;

(e) The Composite Rate, including a detailed explanation of the method by which the Carrier determined the composite rate, including all calculations and data used for the projected distribution of covered lives by age, geographic area and premium payment mode for each Rate Basis Type and developed in the manner prescribed by 211 CMR 41.98;

(f) For Enhanced Benefits Plans, a list and description of each additional benefit or lower cost-sharing requirement included in the plan and the proportion of the proposed premium, if any, associated with each enhancement;

(g) For Alternative Benefits Plans:

(h) The Adjusted Composite Rate for each Closed Guaranteed Issue Health Plan, developed in the manner prescribed by 211 CMR 41.05 and 41.98;

(i) For Carriers that base payments on usual and customary charges for non-contracting providers for Guaranteed Issue Medical Plans and for the out-of-network benefits of Guaranteed Issue Preferred Provider Plans, an actuarial opinion certifying that the Carrier has used a methodology to determine its usual and customary charges that results in usual and customary charges that are, in the aggregate, at least comparable to, and not lower than, the 80th percentile of charges based on Health Insurance Association of America data that are not more than 18 months old, as well as a description of the methodology;

(j) An Actuarial Opinion and Memorandum certifying that the rates have been developed in compliance with M.G.L. c. 176M, § 4, including the specified rate bands and multipliers, and that the proposed rates are reasonable in relation to the benefits provided. The Actuarial Opinion and Memorandum must include an explanation of the basis for the actuary's opinions, with consideration of the actuarial basis for each age, area, premium payment mode and enhancement or alternative benefit in light of the value of benefits and the effects on utilization;

(k) The actual loss ratio for the previous year and the projected loss ratios for the present year and the year for which the rate is being filed;

(l) A comparison of current and proposed rates which shows premium cost components, including expenses, hospital inpatient costs, outpatient costs, the cost of prescription drugs administered on an outpatient basis, and the cost of other medical services, each stated as a percentage of premium;

(m) The name, address and telephone and facsimile transmission numbers of the person responsible for the Rate Filing, if different from the actuary who signed the Actuarial Opinion and Memorandum required in 211 CMR 41.06(2)(i);

(n) A copy of the Carrier's most recent statutory annual report, unless already on file with the Division; and

(o) A certification by a corporate officer stating when the Closed Guaranteed Issue Health Plan's policy form was last filed with the Division, and stating that the policy form has not changed since it was previously filed. If the policy form must be modified to comply with Massachusetts statutory changes, including new mandated benefits or changes to the Standard Benefits Plans, the filing must include revised policy forms, or policy form riders or endorsements necessary to respond to the statutory changes.

(a) A list and definition of each Rate Basis Type which the Carrier has established;

(b) The base premium rate to be charged for each Rate Basis Type;

(c) The adjustments to be applied to each Rate Basis Type's base premium rate based upon age, geographic area, premium payment mode, health benefit, or other rating factor. For each Rate Basis Type, the Rate Filing must contain:

(d) A complete set of proposed rate schedules for each plan, showing proposed rates applicable to each Eligible Individual based upon age, geographic area, premium payment mode, rate basis type, health benefit or any other rating factor;

(e) An Actuarial Opinion and Memorandum certifying that the rates for each plan have been developed in compliance with the requirement that no Carrier shall add any new rating factor to the rating methodology other than that which was applicable to its Closed Plan as of August 15, 1996;

(f) For each plan, the actual loss ratio for the previous year and the projected loss ratios for the present year and the year for which the rate is being filed;

(g) A copy of the Carrier's most recent statutory annual report unless already on file with the Division; and

(h) A certification by a corporate officer stating when the Closed Plan's policy form was last filed with the Division, and stating that the policy form has not changed since it was previously filed. If the policy form must be modified to comply with Massachusetts statutory changes, including new mandated benefits, the filing must include revised policy forms, or policy form riders or endorsements necessary to respond to the statutory changes.