Current through Register No. 12, March 21, 2024
(a) A
group medicare supplement policy form or certificate form shall not be
advertised, solicited, delivered, or issued for delivery unless the policy form
or certificate form can be expected, as estimated for the entire period for
which rates are computed to provide coverage, on the basis of:
(1) Either:
a. Incurred claims experience; or
b. Incurred health care expenses where
coverage is provided by a health maintenance organization on a service rather
than reimbursement basis; and
(2) Earned premiums for such period in
accordance with accepted actuarial principals and practices, to return to
policyholders and certificateholders in the form of aggregate benefits, not
including anticipated refunds or credits, provided under the policy form at
least 75 percent of the aggregate amount of premiums earned.
(b) An individual medicare
supplement policy shall not be advertised, solicited, delivered, or issued for
delivery unless the policy form can be expected, as estimated for the entire
period for which rates are computed to provide coverage, on the basis of:
(1) Incurred claims experience or incurred
health care expenses where coverage is provided by a health maintenance
organization on a service rather than reimbursement basis; and
(2) Earned premiums for such period in
accordance with accepted actuarial principles and practices, to return to
policyholders in the form of aggregate benefits, not including anticipated
refunds or credits, provided under the policy form at least 65 percent of the
aggregate amount of premiums earned.
(c) The return to policyholders and
certificateholders in the form of aggregate benefits of at least 75 percent of
the aggregate amount of premiums earned in the case of group policies and of at
least 65 percent of the aggregate amount of premiums earned in the case of
individual policies shall be deemed the loss ratio standards established by
this rule.
(d) All filings of rates
and rating schedules shall:
(1) Demonstrate
that expected claims in relation to premiums comply with the requirements of
this section when combined with actual experience to date; and
(2) Demonstrate if the filing is for a rate
revision, that the anticipated loss ratio over the entire future period for
which the revised premiums are computed to provide coverage can be expected to
meet the appropriate loss ratio standard as determined by reference to
Ins
1902.09(a) in the case of a group
policy or to
Ins
1902.09(b) in the case of an
individual policy.
(e)
For policies issued prior to July 1, 1992, expected claims in relation to
premium shall meet:
(1) The originally filed
anticipated loss ratio when combined with the actual experience since
inception;
(2) The appropriate loss
ratio requirement from
Ins
1902.09(a) or
Ins
1902.09(b) when combined with actual
experience; and
(3) The appropriate
loss ratio requirement from
Ins
1902.09(a) or
Ins
1902.09(b) over the entire future
period for which the rates are computed to provide coverage.
(f) Rules applicable to refund or
credit calculation reporting shall be as follows:
(1) With respect to Medicare supplement
policies or certificates issued prior to July 1, 1992, the issuer shall make
one refund or credit calculation combining the experience of all the issuer's
individual policies beginning with experience after 12/31/96 and one refund or
credit calculation combining the experience of all the issuer's group policies
beginning with experience after December 31, 1996;
(2) Each issuer shall collect the data
contained in the applicable reporting form contained in Table 1900.03 and,
using this reporting form, file the data with the commissioner;
(3) Reports shall be due on May 31 of each
year;
(4) If, on the basis of the
experience as reported, the benchmark ratio since inception of the reporting
requirement, ratio 1 from line 7 of the reporting form contained in Table
1900.03, exceeds the adjusted experience ratio since inception of the same
reporting requirement, ratio 3 from line 11 of the reporting form contained in
Table 1900.03, then a refund or credit calculation shall be required. The
refund calculation shall be done on a statewide basis;
(5) A refund or credit shall be made only
when the benchmark loss ratio exceeds the adjusted experience loss ratio and
the amount to be refunded or credited exceeds a de minimis level of $5.00 per
individual policy or each individual certificate;
(6) The refund shall include interest
pursuant to
Ins
1905.13(b)(4) from the end of the
calendar year to the date of the refund or credit at a rate specified by the
U.S. Secretary of Health and Human Services but in no event shall it be less
than the average rate of interest for 13-week Treasury notes; and
(7) A refund or credit against premiums due
shall be made by September 30 following the experience year upon which the
refund or credit is based.
(g) An issuer of medicare supplement policies
and certificates in this state shall file annually its premium rates, rating
schedule, and supporting documentation including ratios of incurred to earned
premiums by policy duration.
(h)
For the purpose of this section, policy forms shall be deemed to comply with
the loss ratio standards if:
(1) For the most
recent year, the ratio of the incurred losses to earned premiums, for policies
or certificates which have been in force for 3 years or more is greater than or
equal to the applicable percentages contained in this section;
(2) The expected losses in relation to
premiums over the entire period for which the policy is rated comply with the
requirements of this section; and
(3) An expected 3rd year loss ratio which is
greater than or equal to the applicable percentage shall be demonstrated for
policies or certificates in force less than 3 years.
(i) As soon as practicable, but prior to the
effective date of enhancements in medicare benefits, every issuer of medicare
supplement policies or certificates in this state shall file with the
commissioner in accordance with the applicable filing procedures of this state
the following items:
(1) Appropriate premium
adjustments necessary to produce loss ratios as anticipated for the current
premium for the applicable policies or certificates;
(2) Such supporting documents as necessary to
justify the premium adjustments; and
(3) Any appropriate riders, endorsements or
policy forms needed to accomplish the medicare supplement policy or certificate
modification necessary to eliminate benefit duplications with
medicare.
(j) An insurer
shall make such premium adjustments as are necessary to produce an expected
loss ratio under such policy or certificate as will conform with minimum loss
ratio standards for medicare supplement policies.
(k) Such premium adjustments shall be
expected to result in a loss ratio at least as great as that originally
anticipated in the rates used to produce current premiums by the issuer for
such medicare policies or certificates.
(l) No premium adjustment which would modify
the loss ratio experience under the policy other than the adjustments described
herein shall be made with respect to a policy or certificate at any time other
than upon its renewal date or anniversary date.
(m) Riders, endorsements, or policy forms
filed pursuant to this section shall provide a clear description of the
medicare supplement benefits provided by the policy or certificate.
(n) If presented with a request from an
issuer for an increase in a rate for a policy or certificate form for which the
experience under the form for the previous reporting period is not in
compliance with the applicable loss ratio standard, the commissioner, in order
to gather information, shall, prior to any approval or disapproval of the
request, conduct a public hearing in accordance with
RSA 400-A:17 when:
(1) The issuer requests a public hearing,
or
(2) At least 10 policyholders or
certificate holders request a public hearing.
#1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5119,
eff 4-25-91; ss by #5656, eff 7-1-93; ss by #7017, INTERIM, eff 7-1-99,
EXPIRED: 10-29-99
New. #8555, eff
2-1-06
