|
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 |
|
|