La. Admin. Code tit. 37 § XIII-3141

Current through Register Vol. 50, No. 11, November 20, 2024

Section XIII-3141 - Premium Maximums, Method for Calculating

A. Premiums charged for the LA Health pilot plans shall be based on the average standard rate charged by the five largest health and accident insurers offering individual coverage in the state, as identified by the Louisiana Health Insurance Association's annual survey in accordance to R.S. 22:1213.E.3. Annual survey results may be obtained from the department. For the purpose of calculating the maximum premiums as established in §3141.B of this regulation, insurers shall use the premiums identified in the Louisiana Health Insurance Association's Plan "A" and shall use the strict average of male and female rates.

B. Premium rates shall be community rated within each service area, but may vary according to an enrolled individual's status, (i.e., adult or minor dependent and smoker or nonsmoker), as established in §3141. B 1-3 of this regulation.

1. Adult individual rates shall be based on a per unit basis. Each individual's premium rate enrolled in the plan shall be no more than 60 percent of the strict average of the average individual standard rate charges for adults as identified in §3141. A of this regulation.

2. For the purpose of establishing the premium rate for minor dependents, there shall be one rate regardless of the number of minor dependents enrolled under each plan policy. The premium rate for minor dependents shall be no more than 60 percent of the average individual standard charged for children as identified in §3141. A of this regulation.

3. Rates may vary according to an individual's status as either a smoker or nonsmoker. For those individuals enrolled in the plan as a smoker, premium rates identified in §3141 shall be based on the average individual standard rate charged for smokers as identified in §3141 For those individuals enrolled in the plan as a nonsmoker, premium rates identified in §3141 shall be based on the average individual standard rate charge for nonsmokers as identified in §3141. A of this regulation.

4. Where a sliding scale is utilized for setting an individual or family's premium payment amount (including any contribution which may be made by an employer), the maximum payment amount for the highest income level cannot exceed the upper limits established under §3141. B 1-3 of this regulation.

La. Admin. Code tit. 37, § XIII-3141

Promulgated by the Department of Insurance, Office of the Commissioner, LR 20:1012 (September 1994), Amended LR 49493 (3/1/2023).

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:11, R.S. 22:2241-2247, and the Administrative Procedure Act, R.S. 49:950 et seq.