New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter XIV - Individual And Small Group Health Insurance
Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance
Section 360.10 - Filing and approval of rates by commercial insurers intending to change to a community rating methodology

(i) all small group policies;

(ii) all optionally renewable and conditionally renewable individual policies;

(iii) all policies that are guaranteed renewable, as that term is defined in sections 52.17(a)(5) or (6) and 58.1(b)(1) of this Title issued on or after February 1, 1993, including previously issued policies on such forms issued as guaranteed renewable; and

(iv) all individual or group policies issued pursuant to a statutory or contractual right of conversion, except for conversions from and to guaranteed renewable and noncancellable individual forms issued prior to July 17, 1992.

(i) Revised or new rate manuals which specify policies as active or inactive. The rate manual must list the premium rates themselves, as well as any factors to be utilized in the calculation of the premium rates. Such revised pages or new manuals shall not contain references to, or premiums containing assumptions based upon claims experience, underwriting, substandard ratings, occupational limitations, and other now prohibited factors. Implementation by an insurer of revised rate manual pages, or new rate manuals, is contingent upon the insurer first obtaining the department's prior approval of the premium rates set forth therein.

(ii) An exhibit showing the complete experience for New York issued policyholders since inception, both yearly and in total, through December 31, 1991. Include written and earned premiums, dividends incurred, paid claims, each reserve component, the annual change in each reserve component, incurred claims, and incurred loss ratio for each calendar year. Premium, claim and dividend columns should be totalled to December 31, 1991.

(iii) A statement of the date the form was first offered for issue and the date it ceased to be offered in New York.

(iv) A history of any prior rate changes approved for such form in New York, specifying the percentage rate change and effective date (month, day, year) of each change.

(v) A statement of the ratio of the annualized community premium for the form to the annualized premium in effect as of September 30, 1992 based on each form's inforce on that date.

(vi) An exhibit displaying the results of the following comparative calculations and combinations, all based on each form's inforce as of September 30, 1992.

(vii) For forms to be offered on or after April 1, 1993, and for all forms for which the proposed community rates produce a ratio under subparagraph (v) of this paragraph that is greater than one, a detailed actuarial memorandum conforming to the requirements of section 52.40(d)(1)(i)-(iv), (vi), (vii), (ix), (x) and (xii) of Part 52 of this Title.

(i) Revised or new rate manuals which specify policies as active or inactive. The first page of such manual shall display for active policies the actual schedule of premium rates for representative benefit packages, including the insurer's most commonly sold benefit package. The rate manual must list the premium rates themselves, as well as any factors to be utilized in the calculation of the premium rates, including any rate guarantees. Such rates, factors and the instructions for calculating the specific premium for any benefit package must be filed in consecutively numbered rate manual pages. Such revised pages or new manuals shall not contain references to, or premiums containing assumptions based upon, group claims experience, underwriting, substandard ratings, occupational limitations, and other now prohibited factors. Implementation by an insurer of revised rate manual pages, or new rate manuals, is contingent upon the insurer first obtaining the department's prior approval of the premium rates set forth therein. The premium rates may not be for a period longer than 12 months.

(ii) For calendar year 1991 and separately for the first six months of 1992, an exhibit of the experience of New York insureds under each form (or collection of forms) sold to a distinct market, such as a package of benefits marketed through a multiple employer trust, including written and earned premiums, dividends or experience rating refunds incurred, paid claims, each reserve component as of December 31, 1990, December 31, 1991 and June 30, 1992, incurred claims and incurred loss ratios.

(iii) A statement of the ratio of the annualized community premium for the form (or collection of forms) for each community to the annualized premium in effect for that community, both based on the inforce as of September 30, 1992 for the form(s).

(iv) An exhibit displaying the results of the following comparative calculations and combinations, all based on the inforce as of September 30, 1992 for the form(s):

(v) A detailed actuarial memorandum providing a complete justification of the rates being submitted, including reference to the relevant information used in the development of such justification, and a demonstration that the applicable minimum loss ratio of section 52.45 of Part 52 of this Title will be met. At a minimum, such justification shall include: