LD 1611
pg. 60
Page 59 of 73 PUBLIC Law Chapter 469 Page 61 of 73
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LR 2137
Item 1

 
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 paragraph, 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, not unfairly discriminatory and in
compliance with the requirements of section 6913
remains with the carrier.

 
2-C.__Optional guaranteed loss ratio.__Notwithstanding
subsection 2-B, 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 considered
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
member months for which the rates will be in effect and the
basis for the estimate.__If the superintendent determines
that the number of member months is likely to be less than
1,000 and the block does not satisfy any alternative
credibility standards adopted by rule, the filing is subject
to subsection 2-B.

 
B.__On an annual schedule as determined by the
superintendent, the carrier shall file a report with the
superintendent showing aggregate earned premiums and
incurred claims for the period the rates were in effect.
Incurred claims must include claims paid to a date 6 months
after the end of the annual reporting period determined by
the superintendent and an estimate of unpaid claims.__The
report must state how the unpaid claims estimate was
determined.

 
C.__If incurred claims were less than 78% of aggregate earned
premiums over a continuous 36-month period, the carrier shall
refund a percentage of the premium to the current in-force
policyholder.__For the purposes of


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