LD 1611
pg. 42
Page 41 of 47 An Act To Provide Affordable Health Insurance to Small Businesses and Individua... Page 43 of 47
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LR 2137
Item 1

 
(1)__The rate increase for any group or subgroup does
not exceed the index of inflation multiplied by 1.5,
excluding any approved rate differential based on age.__
For the purposes of this subsection, "index of
inflation" means the rate of increase in medical costs
for a section of the United States selected by the
superintendent that includes this State for the most
recent 12-month period immediately preceding the date
of the filing for which data are available; and

 
(2)__The carrier demonstrates in accordance with
generally accepted actuarial principles and practices
consistently applied that, as of a date no more than
210 days prior to the filing, the ratio of benefits
incurred to premiums earned averages no less than 87.5%
for the previous 12-month period.

 
F.__Any rate hearing conducted with respect to filings that
meet the criteria in paragraph E is subject to this
paragraph.

 
(1)__Any person requesting a hearing shall provide the
superintendent with a written statement detailing the
circumstances that justify a hearing, notwithstanding
the satisfaction of the criteria in paragraph E.

 
(2)__If the superintendent decides to hold a hearing,
the superintendent shall issue a written statement
detailing the circumstances that justify a hearing,
notwithstanding the satisfaction of the criteria in
paragraph E.

 
(3)__In any hearing conducted under this subsection,
the bureau and any party asserting that the rates are
excessive have the burden of establishing that the
rates are excessive.__The burden of proving that rates
are adequate and not unfairly discriminatory remains
with the carrier.

 
2-C.__Optional guaranteed loss ratio.__At the carrier's
option, rate filings for a credible block of small group health
plans may be filed in accordance with this subsection instead of
subsection 2-B.__Rates filed in accordance with this subsection
are filed for informational purposes.

 
A.__A block of small group health plans is deemed credible
if the anticipated number of member months for which the
rates will be in effect is at least 1,000 or if it meets
credibility standards adopted by the superintendent by rule.__
The rate filing must state the anticipated number of


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