Current through Register No. 12, March 21, 2024
(a) Carriers
shall maintain records of earned premiums, incurred claims and reserves for
each calendar year and for each policy form, including data for rider and
endorsement forms that are used with the policy form for so long as the carrier
maintains rates on the policy.
(b)
Notwithstanding (a) above, the carrier:
(1)
May maintain separate data for each rider or endorsement form;
(2) May submit a request to the department to
combine experience for the purposes of evaluating the data for rider and
endorsement forms in relation to premium rates and rate revisions if the rider
and endorsement forms provide similar coverage and provisions, are issued to
similar risk classes, and are issued under similar underwriting standards,
subject to the following:
a. Once a carrier
combines experience pursuant to this paragraph, the carrier shall not again
separate the experience; and
b. The
carrier shall provide experience data for all issue years for all of the rider
and endorsement policy forms that have been combined for this purpose; and
(3) Shall provide the
ratios of actual claims to the claims expected according to the assumptions
underlying the existing rates.
(c) In determining the credibility and
appropriateness of experience data, due consideration shall be given to the
following relevant factors:
(1) Statistical
credibility of premiums and benefits, including:
a. Low exposure; and
b. Low loss frequency;
(2) Experience and projected trends relative
to the kind of coverage, including:
a.
Inflation in medical expenses; and
b. Economic cycles affecting disability
income experience;
(3)
The concentration of experience at early policy durations where select
morbidity and preliminary term reserves are applicable and where loss ratios
are expected to be substantially lower than at later policy durations;
and
(4) The mix of business by risk
classification.
(d) Due
consideration shall be given to the effect of making the following adjustments
on the anticipated loss ratio:
(1)
Substitution of actual claim run-offs for claim reserves and
liabilities;
(2) Determination of
loss ratios with the increase in policy reserves subtracted from premiums
rather than added to benefits;
(3)
Accumulation of experience fund balances;
(4) Substitution of net level policy reserves
for preliminary term policy reserves;
(5) Adjustment of premiums to a monthly mode
basis; and
(6) Other adjustments or
schedules suited to the form and to the records of the company.
(e) The data used to make
adjustments as required in (d) above shall be reconciled to the data required
to calculate the anticipated loss ratio as prescribed.
(f) If a carrier provides a quote to a
policyholder or prospective policyholder, where an alternative design exists
with premium savings that are greater than the anticipated out of pocket
expenses, the carrier shall disclose the availability of this policy
alternative. Deductibles, co-insurance and elimination periods are examples of
benefit designs that shall be considered in calculating this difference.
Variations in co-pays shall not be considered due to uncertainty with regard to
utilization.
(g) Pursuant to (f)
above, this policy alternative shall be made available on a guaranteed issue
basis for renewal quotes.
(h) The
carrier shall provide written notice to individuals in the event that:
(1) The carrier declines to offer coverage as
applied for;
(2) The carrier makes
an offer for coverage similar to any offering of the New Hampshire Health Plan
pursuant to
RSA
415:18, but at a premium rate that is greater
than the New Hampshire Health Plan's premium rate; or
(3) The carrier provides a renewal quote for
coverage similar to any offering of the New Hampshire Health Plan pursuant to
RSA
415:18, but at a premium rate that is greater
than the New Hampshire Health Plan's premium rate;
(i) The notice shall specify:
(1) That the person may be able to purchase
health insurance from the New Hampshire Health Plan pursuant to
RSA
415:18 or the federally qualified high risk
pool pursuant to
RSA
404-G:5-g; and
(2) Contact information for the New Hampshire
Health Plan pursuant to
RSA
415:18 and the federally qualified high risk
pool pursuant to
RSA
404-G:5-g.
#9690, eff 4-9-10; ss by #9938, eff 6-10-11; ss by #10212,
eff 11-1-12 (from
Ins 4103.09
)
The amended
version of this section by
New
Hampshire Register Volume 39, Number 24, eff.6/10/2019 is not yet
available.
