Sale of health care provider policy prohibited, when--determiningfactors--insurer may charge additional premium or grant discount,when--supporting data--rulemaking authority.
383.206. 1. Notwithstanding the provisions of sections 383.037 and383.160, no insurer shall issue or sell in the state of Missouri a policyinsuring a health care provider, as defined in section 538.205, RSMo, fordamages for personal injury or death arising out of the rendering of orfailure to render health care services if the director finds, based uponcompetent and compelling evidence, that the base rates of such insurer areexcessive, inadequate, or unfairly discriminatory. A rate may be used by aninsurer immediately after it has been filed with the director, until or unlessthe director has determined under this section that a rate is excessive,inadequate, or unfairly discriminatory.
2. In making a determination under subsection 1 of this section, thedirector of the department of insurance, financial institutions andprofessional registration may use the following factors:
(1) Rates shall not be excessive or inadequate, nor shall they beunfairly discriminatory;
(2) No rate shall be held to be excessive unless such rate isunreasonably high for the insurance proved with respect to the classificationto which such rate is applicable;
(3) No rate shall be held to be inadequate unless such rate isunreasonably low for the insurance provided with respect to the classificationto which such rate is applicable;
(4) To the extent Missouri loss experience is available, rates andprojected losses shall be based on Missouri loss experience and not theinsurance company's or the insurance industry's loss experiences in statesother than Missouri unless the failure to do so jeopardizes the financialstability of the insurer; provided however, that loss experiences relating tothe specific proposed insured occurring outside the state of Missouri may beconsidered in allowing a surcharge to such insured's premium rate;
(5) Investment income or investment losses of the insurance company forthe ten-year period prior to the request for rate approval may be consideredin reviewing rates. Investment income or investment losses for a period ofless than ten years shall not be considered in reviewing rates. Industrywideinvestment income or investment losses for the ten-year period prior to therequest for rate approval may be considered for any insurance company that hasnot been authorized to issue insurance for more than ten years;
(6) The locale in which the health care practice is occurring;
(7) Inflation;
(8) Reasonable administrative costs of the insurer;
(9) Reasonable costs of defense of claims against Missouri health careproviders;
(10) A reasonable rate of return on investment for the owners orshareholders of the insurer when compared to other similar investments at thetime of the rate request; except that, such factor shall not be used to offsetlosses in other states or in activities of the insurer other than the sale ofpolicies of insurance to Missouri health care providers; and
(11) Any other reasonable factors may be considered in the disapprovalof the rate request.
3. The director's determination under subsection 1 of this section ofwhether a base rate is excessive, inadequate, or unfairly discriminatory maybe based on any subcategory or subspecialty of the health care industry thatthe director determines to be reasonable.
4. If actuarially supported and included in a filed rate, rating plan,rule, manual, or rating system, an insurer may charge an additional premium orgrant a discount rate to any health care provider based on criteria as itrelates to a specified insured health care provider or other specific healthcare providers within the specific insured's employ or business entity. Suchcriteria may include:
(1) Loss experiences;
(2) Training and experience;
(3) Number of employees of the insured entity;
(4) Availability of equipment, capital, or hospital privileges;
(5) Loss prevention measures taken by the insured;
(6) The number and extent of claims not resulting in losses;
(7) The specialty or subspecialty of the health care provider;
(8) Access to equipment and hospital privileges; and
(9) Any other reasonable criteria identified by the insurer and filedwith the department of insurance, financial institutions and professionalregistration.
5. Supporting actuarial data shall be filed in support of a rate, ratingplan, or rating system filing, when requested by the director to determinewhether rates should be disapproved as excessive, inadequate, or unfairlydiscriminatory, whether or not the insurer has begun using the rate.
6. The director of the department of insurance, financial institutionsand professional registration shall promulgate rules for the administrationand enforcement of this section. Any rule or portion of a rule, as that termis defined in section 536.010, RSMo, that is created under the authoritydelegated in this section shall become effective only if it complies with andis subject to all of the provisions of chapter 536, RSMo, and, if applicable,section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverableand if any of the powers vested with the general assembly pursuant to chapter536, RSMo, to review, to delay the effective date, or to disapprove and annula rule are subsequently held unconstitutional, then the grant of rulemakingauthority and any rule proposed or adopted after August 28, 2006, shall beinvalid and void.
Sale of health care provider policy prohibited, when--determiningfactors--insurer may charge additional premium or grant discount,when--supporting data--rulemaking authority.
383.206. 1. Notwithstanding the provisions of sections 383.037 and383.160, no insurer shall issue or sell in the state of Missouri a policyinsuring a health care provider, as defined in section 538.205, RSMo, fordamages for personal injury or death arising out of the rendering of orfailure to render health care services if the director finds, based uponcompetent and compelling evidence, that the base rates of such insurer areexcessive, inadequate, or unfairly discriminatory. A rate may be used by aninsurer immediately after it has been filed with the director, until or unlessthe director has determined under this section that a rate is excessive,inadequate, or unfairly discriminatory.
2. In making a determination under subsection 1 of this section, thedirector of the department of insurance, financial institutions andprofessional registration may use the following factors:
(1) Rates shall not be excessive or inadequate, nor shall they beunfairly discriminatory;
(2) No rate shall be held to be excessive unless such rate isunreasonably high for the insurance proved with respect to the classificationto which such rate is applicable;
(3) No rate shall be held to be inadequate unless such rate isunreasonably low for the insurance provided with respect to the classificationto which such rate is applicable;
(4) To the extent Missouri loss experience is available, rates andprojected losses shall be based on Missouri loss experience and not theinsurance company's or the insurance industry's loss experiences in statesother than Missouri unless the failure to do so jeopardizes the financialstability of the insurer; provided however, that loss experiences relating tothe specific proposed insured occurring outside the state of Missouri may beconsidered in allowing a surcharge to such insured's premium rate;
(5) Investment income or investment losses of the insurance company forthe ten-year period prior to the request for rate approval may be consideredin reviewing rates. Investment income or investment losses for a period ofless than ten years shall not be considered in reviewing rates. Industrywideinvestment income or investment losses for the ten-year period prior to therequest for rate approval may be considered for any insurance company that hasnot been authorized to issue insurance for more than ten years;
(6) The locale in which the health care practice is occurring;
(7) Inflation;
(8) Reasonable administrative costs of the insurer;
(9) Reasonable costs of defense of claims against Missouri health careproviders;
(10) A reasonable rate of return on investment for the owners orshareholders of the insurer when compared to other similar investments at thetime of the rate request; except that, such factor shall not be used to offsetlosses in other states or in activities of the insurer other than the sale ofpolicies of insurance to Missouri health care providers; and
(11) Any other reasonable factors may be considered in the disapprovalof the rate request.
3. The director's determination under subsection 1 of this section ofwhether a base rate is excessive, inadequate, or unfairly discriminatory maybe based on any subcategory or subspecialty of the health care industry thatthe director determines to be reasonable.
4. If actuarially supported and included in a filed rate, rating plan,rule, manual, or rating system, an insurer may charge an additional premium orgrant a discount rate to any health care provider based on criteria as itrelates to a specified insured health care provider or other specific healthcare providers within the specific insured's employ or business entity. Suchcriteria may include:
(1) Loss experiences;
(2) Training and experience;
(3) Number of employees of the insured entity;
(4) Availability of equipment, capital, or hospital privileges;
(5) Loss prevention measures taken by the insured;
(6) The number and extent of claims not resulting in losses;
(7) The specialty or subspecialty of the health care provider;
(8) Access to equipment and hospital privileges; and
(9) Any other reasonable criteria identified by the insurer and filedwith the department of insurance, financial institutions and professionalregistration.
5. Supporting actuarial data shall be filed in support of a rate, ratingplan, or rating system filing, when requested by the director to determinewhether rates should be disapproved as excessive, inadequate, or unfairlydiscriminatory, whether or not the insurer has begun using the rate.
6. The director of the department of insurance, financial institutionsand professional registration shall promulgate rules for the administrationand enforcement of this section. Any rule or portion of a rule, as that termis defined in section 536.010, RSMo, that is created under the authoritydelegated in this section shall become effective only if it complies with andis subject to all of the provisions of chapter 536, RSMo, and, if applicable,section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverableand if any of the powers vested with the general assembly pursuant to chapter536, RSMo, to review, to delay the effective date, or to disapprove and annula rule are subsequently held unconstitutional, then the grant of rulemakingauthority and any rule proposed or adopted after August 28, 2006, shall beinvalid and void.
Sale of health care provider policy prohibited, when--determiningfactors--insurer may charge additional premium or grant discount,when--supporting data--rulemaking authority.
383.206. 1. Notwithstanding the provisions of sections 383.037 and383.160, no insurer shall issue or sell in the state of Missouri a policyinsuring a health care provider, as defined in section 538.205, RSMo, fordamages for personal injury or death arising out of the rendering of orfailure to render health care services if the director finds, based uponcompetent and compelling evidence, that the base rates of such insurer areexcessive, inadequate, or unfairly discriminatory. A rate may be used by aninsurer immediately after it has been filed with the director, until or unlessthe director has determined under this section that a rate is excessive,inadequate, or unfairly discriminatory.
2. In making a determination under subsection 1 of this section, thedirector of the department of insurance, financial institutions andprofessional registration may use the following factors:
(1) Rates shall not be excessive or inadequate, nor shall they beunfairly discriminatory;
(2) No rate shall be held to be excessive unless such rate isunreasonably high for the insurance proved with respect to the classificationto which such rate is applicable;
(3) No rate shall be held to be inadequate unless such rate isunreasonably low for the insurance provided with respect to the classificationto which such rate is applicable;
(4) To the extent Missouri loss experience is available, rates andprojected losses shall be based on Missouri loss experience and not theinsurance company's or the insurance industry's loss experiences in statesother than Missouri unless the failure to do so jeopardizes the financialstability of the insurer; provided however, that loss experiences relating tothe specific proposed insured occurring outside the state of Missouri may beconsidered in allowing a surcharge to such insured's premium rate;
(5) Investment income or investment losses of the insurance company forthe ten-year period prior to the request for rate approval may be consideredin reviewing rates. Investment income or investment losses for a period ofless than ten years shall not be considered in reviewing rates. Industrywideinvestment income or investment losses for the ten-year period prior to therequest for rate approval may be considered for any insurance company that hasnot been authorized to issue insurance for more than ten years;
(6) The locale in which the health care practice is occurring;
(7) Inflation;
(8) Reasonable administrative costs of the insurer;
(9) Reasonable costs of defense of claims against Missouri health careproviders;
(10) A reasonable rate of return on investment for the owners orshareholders of the insurer when compared to other similar investments at thetime of the rate request; except that, such factor shall not be used to offsetlosses in other states or in activities of the insurer other than the sale ofpolicies of insurance to Missouri health care providers; and
(11) Any other reasonable factors may be considered in the disapprovalof the rate request.
3. The director's determination under subsection 1 of this section ofwhether a base rate is excessive, inadequate, or unfairly discriminatory maybe based on any subcategory or subspecialty of the health care industry thatthe director determines to be reasonable.
4. If actuarially supported and included in a filed rate, rating plan,rule, manual, or rating system, an insurer may charge an additional premium orgrant a discount rate to any health care provider based on criteria as itrelates to a specified insured health care provider or other specific healthcare providers within the specific insured's employ or business entity. Suchcriteria may include:
(1) Loss experiences;
(2) Training and experience;
(3) Number of employees of the insured entity;
(4) Availability of equipment, capital, or hospital privileges;
(5) Loss prevention measures taken by the insured;
(6) The number and extent of claims not resulting in losses;
(7) The specialty or subspecialty of the health care provider;
(8) Access to equipment and hospital privileges; and
(9) Any other reasonable criteria identified by the insurer and filedwith the department of insurance, financial institutions and professionalregistration.
5. Supporting actuarial data shall be filed in support of a rate, ratingplan, or rating system filing, when requested by the director to determinewhether rates should be disapproved as excessive, inadequate, or unfairlydiscriminatory, whether or not the insurer has begun using the rate.
6. The director of the department of insurance, financial institutionsand professional registration shall promulgate rules for the administrationand enforcement of this section. Any rule or portion of a rule, as that termis defined in section 536.010, RSMo, that is created under the authoritydelegated in this section shall become effective only if it complies with andis subject to all of the provisions of chapter 536, RSMo, and, if applicable,section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverableand if any of the powers vested with the general assembly pursuant to chapter536, RSMo, to review, to delay the effective date, or to disapprove and annula rule are subsequently held unconstitutional, then the grant of rulemakingauthority and any rule proposed or adopted after August 28, 2006, shall beinvalid and void.
