20-2311

20-2311. Premium rates and rating
practices

A. The premium rate that an accountable health plan charges during a rating period
for a health benefits plan issued to a small employer shall not vary by more than sixty
per cent from the index rate for health benefits plans involving the same or similar
coverage, family size and composition, and geographic area.

B. In establishing premium rates for health benefits plans offered to small
employers:

1. An accountable health plan making adjustments with respect to demographic
characteristics shall apply those adjustments consistently across all small employers.

2. An accountable health plan may not use a geographic area that is smaller than a
county or smaller than an area that includes all areas in which the first three digits of
the zip code are identical, whichever is smaller.

C. The percentage increase in the premium rate that is charged to a small employer
for a new rating period may not exceed the sum of the following:

1. The percentage change in the base premium rate.

2. Fifteen percentage points.

3. Any adjustment due to a change in coverage, family size or composition,
geographic area or demographic characteristics.

D. At the time an accountable health plan offers a health benefits plan to a small
employer, the accountable health plan shall fully disclose to the employer all of the
following:

1. Rating practices for small employer health benefits plans, including rating
practices for different populations and benefit designs.

2. The extent to which premium rates for the small employer are established or
adjusted based on the actual or expected variation in claims costs or health condition of
the employees of the small employer and their dependents.

3. The accountable health plan's right to change premium rates, the extent to which
premiums can be modified and the factors that affect changes in premium rates.

E. Each accountable health plan shall file annually with the director a written
statement by a member of the American academy of actuaries or another individual
acceptable to the director certifying that based on an examination by the individual,
including a review of the appropriate records and of the actuarial assumptions of the
accountable health plan and methods used by the accountable health plan in establishing
base premium rates, index rates and premium rates for small employer health benefits
plans:

1. The accountable health plan is in compliance with the applicable provisions of
this article.

2. The rating methods are actuarially sound.

F. Each accountable health plan shall retain a copy of the statement required by
subsection E for examination at its principal place of business.

G. Each accountable health plan shall annually file with the director for
informational purposes the accountable health plan's base premium rates and index rates.
On request, the director shall make the base premium rates or the index rates available
to the public for inspection.