Current through Register No. 12, March 21, 2024
(a) Carriers shall
calculate the market rate in accordance with the following:
(1) The calculation shall reflect the
carrier's experience for all the products it sells and maintains in the
individual health insurance market;
(2) Plan relativity factors that are used to
modify the carrier's experience to a common market rate shall be the same
factors that were used to calculate the health coverage plan rates during the
experience period;
(3) The market
rate shall be normalized for the average plan relativity factor; and
(4) Other assumptions used by the carrier in
the calculation of the market rate shall be specified.
(b) The carrier shall calculate from the
market rate the health coverage plan rates for the coverages it will offer. The
carrier shall provide plan relativity factors used to calculate the health
coverage plan rates from the market rate. Any changes to the health coverage
plan rates from the previously approved set of plan relativity factors shall be
highlighted and the basis for the same shall be documented;
(c) Carriers shall calculate premium rates
for individual policyholders from the health coverage plan rates through the
application of factors for allowable case characteristics as follows:
(1) Carriers may use attained age, however
the ratio of the largest factor attributable to age to the lowest factor
attributable to age shall not exceed 4.0;
(2) Carriers may use health status, however
the ratio of the largest factor attributable to health status to the lowest
factor attributable to health status shall not exceed 1.5; and
(3) Carriers may use tobacco use, however the
ratio of the largest factor attributable to tobacco use to the lowest factor
attributable to tobacco use shall not exceed 1.5.
(d) All submissions shall:
(1) Include an actuarial certification and an
actuarial memorandum consisting of various sections as prescribed
herein;
(2) Be provided as
electronic documents, in formats as prescribed herein; and
(3) Be attached to the SERFF filing under the
supporting documents tab with the named components as prescribed
herein.
(e) The
actuarial memorandum shall include a component labeled "Public Information"
that contains a Microsoft Excel or compatible workbook that includes:
(1) A worksheet named "Cover Sheet" that
includes the following information:
a.
Contact information; and
b. A
statement indicating that the filing includes all of the carriers individual
health insurance rates, or an explanation as to why it does not;
(2) A worksheet named "Proposed
Rate Change and Enrollment By Health Coverage Plan" that includes the following
information for each health coverage plan:
a.
Plan codes or suitable plan identifier;
b. The number of expected or enrolled
policyholders and covered dependents;
c. The number of expected or enrolled
policyholders and covered dependents that will be impacted by the proposed rate
change; and
d. The proposed health
coverage plan rate;
(3)
A worksheet named "Plan Design and Plan Relativity Factors" that includes the
following information:
a. Carrier plan code
or name;
b. PCP office visit
copay;
c. Specialist office visit
copay;
d. Emergency department
copay;
e. Outpatient surgery
copay;
f. In-network single
deductible;
g. In-network
coinsurance;
h. In-network single
out-of-pocket maximum;
i.
Indication if the deductible applies to all medical services;
j. Services to which the deductible does not
apply;
k. Indication if the
deductible applies to pharmacy services;
l. Indication if preventive services are
covered in full;
m. Indication if
the health coverage plan type covers mental health and substance
services;
n. Indication if the
health coverage plan has a tiered network component;
o. Retail pharmacy single deductible
generic;
p. Retail pharmacy single
deductible brand formulary;
q.
Retail pharmacy single deductible brand non-formulary;
r. Retail pharmacy copay generic;
s. Retail pharmacy copay brand
formulary;
t. Retail pharmacy copay
brand non-formulary;
u. Plan
relativity factors for proposed rates;
v. Policy form number;
w. Indication if the health coverage plan is
open or closed;
x. Indication if
the health coverage plan is grandfathered or non-grandfathered by federal
definition;
y. Renewability of the
health coverage plan;
z. General
marketing method;
aa. Issue age
limits; and
ab. Indication if the
health coverage plan is new;
(4) A worksheet named "Experience Used in the
Rate Development" that includes a brief description of the source for the
experience data and PMPM claims information for:
a. Inpatient facility;
b. Outpatient facility;
c. Professional services;
d. Prescription drugs;
e. Capitation arrangements;
f. Other provider payments; and
g. Other;
(5) A worksheet named "Administrative
Charges" that includes administrative charges as PMPM amounts;
(6) A worksheet named "Retention Charges"
that includes information for retention charges segmented by:
a. Administrative costs;
b. Investment income credits;
c. Contributions to surplus or profit;
and
d. Other;
(7) A worksheet named "Illustrative Rates"
that delineates the final rates for 2 hypothetical policyholders;
(8) A worksheet named "Summary of Rating
Factors" that provides information regarding the carrier's utilization of
allowable rating factors;
(9) A
worksheet named "Health Coverage Plan Rate PMPM Development for Standard Health
Coverage Plan" that delineates how the health coverage plan rate is calculated
for prescribed standard plans including the following information:
a. PMPM experience data;
b. Annual trend factor;
c. Months of trend;
d. Trend adjustments; and
e. PMPM retention; and
(10) A worksheet named "Medical Loss Ratio
Exhibit for Individual Market" that includes documentation regarding
calculation of the anticipated loss ratios with the following information:
a. Member months;
b. Incurred claims;
c. Earned premium;
d. Quality improvement expenses;
e. Earned premium adjustments; and
f. Interest rate assumptio.
(f) The actuarial
memorandum shall include a component on the supporting documentation tab
labeled "Supporting Public Information" with an attached PDF document that
includes:
(1) An exhibit titled "Discussion of
Credibility" that includes references to the sources for experience data,
limitation on using plan specific experience and any explanation for experience
adjustments;
(2) An exhibit titled
"Illustrative Rates" that delineates the rate development for 2 hypothetical
policyholders;
(3) An exhibit
titled "Rating Factors" that includes rate factor tables for each rating
factor;
(4) An exhibit titled
"Expected Distribution of Rating Factors" that includes information delineating
the expected distribution of membership by allowable rating factors with tier
and conversion factors; and
(5) An
exhibit titled "Description of Methodology for the Projected Medical Loss
Ratio" that includes a discussion of data sources and pricing assumptions used
to calculate the anticipated loss ratio.
(g) The actuarial memorandum shall include a
component on the supporting documentation tab labeled "Confidential
Information" that contains a Microsoft Excel or compatible workbook that
includes a worksheet named "Detail on Final Trend Assumptions" with trend
assumptions segmented by:
(1) Service
categories, including:
a. Inpatient
facility;
b. Outpatient
facility;
c. Professional
services;
d. Prescription drugs;
and
e. Other; and
(2) Changes in:
a. Unit cost; and
b. Utilization.
(h) The actuarial memorandum shall
include a component on the supporting documentation tab labeled "Supporting
Confidential Information" with an attached PDF document that includes:
(1) An exhibit titled "Description of Trend
Development" that includes an explanation of the process used to develop trend
assumptions; and
(2) An exhibit
titled "Supporting Schedules for Trend Development" that includes documentation
and other data to support the trend assumptions.
(i) Actuarial memoranda for rate revisions
shall modify the worksheets required above as follows:
(1) The worksheet named "Cover Sheet" shall
include the following additional information:
a. A statement certifying that there have
been no changes to rating methodology since the most recently approved filing
or a brief description of any such proposed changes; and
b. A statement certifying that there have
been no benefit changes to any of the plans for which rates are being revised
or a description of those benefit changes;
(2) The worksheet named "Proposed Rate Change
and Enrollment by Health Coverage Plan" shall include the following additional
information:
a. PMPM health coverage plan rate
in effect 12 months prior to the proposed rate effective date; and
b. PMPM health coverage plan rate from the
most recently approved filing;
(3) The worksheet named "Plan Design and Plan
Relativity Factors" shall include:
a. Plan
relativities for coverage in effect on the rate effective date one year prior
to the rate filing effective date; and
b. Supporting documentation for plan
relativity factor changes that exceed 5%;
(4) The worksheet named "Detail on Final
Trend Assumptions" shall include the total annualized trend assumption from the
most recently approved rate filing;
(5) The worksheet named "Administrative
Charges" shall include:
a. The administrative
charges used for coverages in effect on the rate effective date one year prior
to the rating filing effective date; and
b. The administrative charges from the
carrier's most recently approved filing;
(6) The worksheet named "Retention Charges"
shall include:
a. The retention charges used
for coverages in effect on the rate effective date one year prior to the rate
filing effective date; and
b. The
retention charges from the carrier's most recently approved filing;
(7) The worksheet named "Summary
of Rating Factors" shall include an indication as to which of the rating
factors have changed since the most recently approved rate filing;
and
(8) The worksheet named "Health
Coverage Plan Rate PMPM Development for Standard Health Coverage Plan" shall
include:
a. The standard health coverage plan
rates, PMPM, for coverages in effect on the rate effective date one year prior
to the rate filing effective date; and
b. The standard health coverage plan rates,
PMPM, which were approved in the carrier's most recently approved
filing.
(j)
Actuarial memoranda for rate revisions shall include a component titled
"Additional Required Public Information for Rate Revisions" that contains a
Microsoft Excel or compatible workbook with the following:
(1) A worksheet named "History of Rate
Changes" that summarizes rate filings the carrier made over the prior 3 years
including:
a. The rate effective
date;
b. The average, annual
proposed rate change; and
c. The
average, annual approved rate change.
(2) A worksheet named "Distribution of Rate
Changes" that includes the number of enrolled policyholders and covered
dependents that will be impacted by the proposed change segmented by the
anticipated rate change; and
(3) A
worksheet named "Components of Average Proposed Rate Change" that includes the
average rate change attributable to rate changes in:
a. Utilization;
b. Unit costs;
c. Retention;
d. Benefit changes required by law;
e. Other benefit changes;
f. Over or under statement of prior rates;
and
g. Other.
(k) The actuarial memorandum for
rate revisions shall include a component on the supporting documentation tab
titled "Supporting Documentation for the Additional Required Public Information
for Rate Revisions" with a PDF document titled "Description of Rating Factors"
that includes supporting documentation for ay proposed changes to the rating
factors.
(l) Carriers shall submit
a complete filing, at least annually, that includes all of the documentation
required for rate revisions even if no changes in rates are being proposed. The
purpose of the rate filing shall be to demonstrate that the continued use of
the previously approved rates is appropriate.
(m) All submissions shall include an
actuarial certification provided as a PDF document attached to the supporting
documentation tab under the public information component with the following
statements:
(1) A statement indicating that
the filing conforms to generally accepted actuarial principals;
(2) A statement that the entire filing is in
compliance with all applicable laws and rules;
(3) A statement that the premiums are not
inadequate, excessive, unfairly discriminatory, or unreasonable in relation to
the benefits;
(4) A statement that
variations in health coverage plan rates:
a.
Shall not exceed the maximum possible difference in benefits unless they are
based on the following:
1. Expected
utilization differences attributable to plan design;
2. Expected administrative cost differences
attributable to plan design; and
3.
Provider reimbursement variances attributable to plan design; and
b. Do not vary based on the health
status/morbidity or other demographics of the populations electing the varying
plans;
(5) A statement
indicating that premium rates are calculated from health coverage plan rates
and that premium rates vary from health coverage plan rates using only
allowable rating factors;
(6) A
statement that benefits are neither excluded nor vary by any of the allowable
rating factors; and
(7) A statement
indicating that the health plan coverages for which rates are being filed are
being actively marketed and are available to both new issues and renewing
policyholders.
(n)
Carriers shall use the calendar year as the rate effective period, such that:
(1) Rates quoted and established for new
issues and renewals shall not vary within the rate effective period;
and
(2) Rates shall be guaranteed
to the policyholder, and shall not change, for 12 months from issue or
renewal.
(o) Carriers
shall file rates each year on or before the uniform filing date established by
the department, consistent with annual guidance from the Center for Medicare
and Medicaid Services ("CMS"), for the coming calendar year. For rates subject
to 45 CFR Part 154, carriers shall, in addition to filing with the department,
make all filings required with CMS under federal regulations.
(p) Final approved rates for all individual
market filings shall be available for public review no later than the start of
the annual open enrollment period set by the U.S. Department of Health and
Human Services pursuant to 42 U.S.C. 1803 l(c)(6)(B).
(q) In accordance with
RSA 91-A:5, IV, the
department shall maintain the confidentiality of the commercial and proprietary
trend assumptions and supporting documentation that is required to be submitted
under
Ins 4102.07(g) and
(h).
#9690, eff 4-9-10; ss by #9938, eff 6-10-11; ss by #10212,
eff 11-1-12 (from
Ins 4103.07
)
The amended
version of this section by
New
Hampshire Register Volume 39, Number 24, eff.6/10/2019 is not yet
available.
