Section 58-17-125 - Premium rates to be reasonable--Establishment of rates--Determination ofaverage rates--Actuarial adjustment. - South-dakota Statutes

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Statutes > South-dakota > Title-58 > Chapter-17 > Statute-58-17-125

58-17-125. Premium rates to be reasonable--Establishment of rates--Determination of average rates--Actuarial adjustment. The premium rates for coverages provided by the risk pool may not be unreasonable in relation to the benefits provided, the risk experience, and the reasonable expenses of providing coverage. Case characteristics as allowed pursuant to § 58-17-74 may be used in establishing rates for those covered by the risk pool. The rates shall take into consideration the extra morbidity and administrative expenses, if any, for enrollees in the risk pool. The rates for a given classification for those that qualify for coverage pursuant to § 58-17-85 shall be one hundred fifty percent of the average actively marketed premium or payment rate for that classification charged by the carriers with the largest number of individual health benefit plans in the state during the preceding calendar year. For purposes of this section, only individual health benefit plans that are being actively marketed to the general public may be utilized in determining the largest carriers. The board shall select a sufficient number of carriers from which to calculate the average so that at least ninety percent of the market is represented and the carriers selected sequentially have the largest number of actively marketed health benefit plans. The number of carriers selected may not be less than three. In determining the average rate of the largest individual health carriers, the rates or payments charged by the carriers shall be actuarially adjusted to determine the rate or payment that would have been charged for benefits similar to those provided by the risk pool.

Source: SL 2003 (SS), ch 1, § 13; SL 2010, ch 238, § 1.

State Codes and Statutes

Statutes > South-dakota > Title-58 > Chapter-17 > Statute-58-17-125

58-17-125. Premium rates to be reasonable--Establishment of rates--Determination of average rates--Actuarial adjustment. The premium rates for coverages provided by the risk pool may not be unreasonable in relation to the benefits provided, the risk experience, and the reasonable expenses of providing coverage. Case characteristics as allowed pursuant to § 58-17-74 may be used in establishing rates for those covered by the risk pool. The rates shall take into consideration the extra morbidity and administrative expenses, if any, for enrollees in the risk pool. The rates for a given classification for those that qualify for coverage pursuant to § 58-17-85 shall be one hundred fifty percent of the average actively marketed premium or payment rate for that classification charged by the carriers with the largest number of individual health benefit plans in the state during the preceding calendar year. For purposes of this section, only individual health benefit plans that are being actively marketed to the general public may be utilized in determining the largest carriers. The board shall select a sufficient number of carriers from which to calculate the average so that at least ninety percent of the market is represented and the carriers selected sequentially have the largest number of actively marketed health benefit plans. The number of carriers selected may not be less than three. In determining the average rate of the largest individual health carriers, the rates or payments charged by the carriers shall be actuarially adjusted to determine the rate or payment that would have been charged for benefits similar to those provided by the risk pool.

Source: SL 2003 (SS), ch 1, § 13; SL 2010, ch 238, § 1.

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Statutes > South-dakota > Title-58 > Chapter-17 > Statute-58-17-125

58-17-125. Premium rates to be reasonable--Establishment of rates--Determination of average rates--Actuarial adjustment. The premium rates for coverages provided by the risk pool may not be unreasonable in relation to the benefits provided, the risk experience, and the reasonable expenses of providing coverage. Case characteristics as allowed pursuant to § 58-17-74 may be used in establishing rates for those covered by the risk pool. The rates shall take into consideration the extra morbidity and administrative expenses, if any, for enrollees in the risk pool. The rates for a given classification for those that qualify for coverage pursuant to § 58-17-85 shall be one hundred fifty percent of the average actively marketed premium or payment rate for that classification charged by the carriers with the largest number of individual health benefit plans in the state during the preceding calendar year. For purposes of this section, only individual health benefit plans that are being actively marketed to the general public may be utilized in determining the largest carriers. The board shall select a sufficient number of carriers from which to calculate the average so that at least ninety percent of the market is represented and the carriers selected sequentially have the largest number of actively marketed health benefit plans. The number of carriers selected may not be less than three. In determining the average rate of the largest individual health carriers, the rates or payments charged by the carriers shall be actuarially adjusted to determine the rate or payment that would have been charged for benefits similar to those provided by the risk pool.

Source: SL 2003 (SS), ch 1, § 13; SL 2010, ch 238, § 1.