State Codes and Statutes

Statutes > Nebraska > Chapter44 > 44-4227

44-4227. Premium and standard risk rates;how determined.(1)(a) Forcalendar years prior to January 1, 2010, rates and rate schedulesmay be adjusted for appropriate risk factors such as age, sex, and area variationin claim costs in accordance with established actuarial and underwriting practices.Special rates shall be provided for children under eighteen years of age.(b) For calendar years prior to January1, 2010, the pool, with the assistance of an independent actuary,shall determine the standard risk rate by calculating the average individualrate charged by the five insurers writing the largest amount of individualhealth insurance coverage in the state actuarially adjusted to be comparablewith the pool coverage, except that such five insurers shall not include anyinsurer which has not been writing individual health insurance coverage inthis state in at least the three preceding calendar years. The selection ofthe independent actuary shall be subject to the approval of the director.In the event five insurers do not offer comparable coverage, the standardrisk rate shall be established using reasonable actuarial techniques and shallreflect anticipated risk experience and expenses for such coverage. The annualpremium rate established for pool coverage shall be one hundred thirty-fivepercent of rates established as applicable for individual standard risks,except that the annual premium rate established for pool coverage for childrenunder eighteen years of age shall be sixty-seven and five-tenths percent ofrates established as applicable for individual standard risks. (2)(a) For calendar years beginning onand after January 1, 2010, rates and rate schedules may be adjusted for appropriaterisk factors such as age, sex, and area variation in claim costs in accordancewith established actuarial and underwriting practices.(b)(i) For calendar years beginning onand after January 1, 2010, the pool, with the assistance of an independentactuary, shall determine the standard risk rate by calculating the averageindividual rate charged by the ten insurers writing the largest amount ofindividual health insurance coverage in the state actuarially adjusted tobe comparable with the pool coverage, except that such ten insurers shallnot include any insurer which has not been writing individual health insurancecoverage in this state in at least the three preceding calendar years. Theselection of the independent actuary shall be subject to the approval of thedirector. In the event ten insurers do not offer comparable coverage, thestandard risk rate shall be established using reasonable actuarial techniquesand shall reflect anticipated risk experience and expenses for such coverage.(ii)(A) The annual premium rate establishedfor pool coverage for calendar year 2010 (I) shall be one hundred forty percentof rates established as applicable for individual standard risks or (II) shallbe the rates established as applicable for individual standard risks for theprevious calendar year adjusted by a trend factor reflecting medical economicfactors as the board deems appropriate, whichever is greater.(B) The annual premium rate establishedfor pool coverage for calendar year 2011 (I) shall be one hundred forty-fivepercent of rates established as applicable for individual standard risks or(II) shall be the rates established as applicable for individual standardrisks for the previous calendar year adjusted by a trend factor reflectingmedical economic factors as the board deems appropriate, whichever is greater.(C) The annual premium rate establishedfor pool coverage for calendar year 2012 and each calendar year thereafter(I) shall be one hundred fifty percent of rates established as applicablefor individual standard risks or (II) shall be the rates established as applicablefor individual standard risks for the previous calendar year adjusted by atrend factor reflecting medical economic factors as the board deems appropriate,whichever is greater.(3) The board shall not adjustor increase pool rates more than one time during any calendar year. All ratesand rate schedules shall be submitted to the director for approval. The directorshall hold a public hearing pursuant to the Administrative Procedure Act priorto approving an adjustment to or increase in pool rates. SourceLaws 1985, LB 391, § 27; Laws 1989, LB 279, § 9; Laws 1990, LB 1136, § 107; Laws 1991, LB 419, § 4; Laws 1992, LB 1006, § 40; Laws 1998, LB 1063, § 3; Laws 2000, LB 1253, § 29; Laws 2009, LB358, § 8. Cross ReferencesAdministrative Procedure Act, see section 84-920.