N.H. Admin. Code § Ins 4102.06

Current through Register No. 50, December 12, 2024

Section Ins 4102.06 - Data Considerations and Notice Requirements

(a) Carriers shall maintain records of earned premiums, incurred claims and reserves for each calendar year and for each policy form, including data for rider and endorsement forms that are used with the policy form for so long as the carrier maintains rates on the policy.

(b) Notwithstanding (a) above, the carrier:

(1) May maintain separate data for each rider or endorsement form;

(2) May submit a request to the department to combine experience for the purposes of evaluating the data for rider and endorsement forms in relation to premium rates and rate revisions if the rider and endorsement forms provide similar coverage and provisions, are issued to similar risk classes, and are issued under similar underwriting standards, subject to the following:

a. Once a carrier combines experience pursuant to this paragraph, the carrier shall not again separate the experience; and

b. The carrier shall provide experience data for all issue years for all of the rider and endorsement policy forms that have been combined for this purpose; and

(3) Shall provide the ratios of actual claims to the claims expected according to the assumptions underlying the existing rates.

(c) In determining the credibility and appropriateness of experience data, due consideration shall be given to the following relevant factors:

(1) Statistical credibility of premiums and benefits, including:

a. Low exposure; and

b. Low loss frequency;

(2) Experience and projected trends relative to the kind of coverage, including:

a. Inflation in medical expenses; and

b. Economic cycles affecting disability income experience;

(3) The concentration of experience at early policy durations where select morbidity and preliminary term reserves are applicable and where loss ratios are expected to be substantially lower than at later policy durations; and

(4) The mix of business by risk classification.

(d) Due consideration shall be given to the effect of making the following adjustments on the anticipated loss ratio:

(1) Substitution of actual claim run-offs for claim reserves and liabilities;

(2) Determination of loss ratios with the increase in policy reserves subtracted from premiums rather than added to benefits;

(3) Accumulation of experience fund balances;

(4) Substitution of net level policy reserves for preliminary term policy reserves;

(5) Adjustment of premiums to a monthly mode basis; and

(6) Other adjustments or schedules suited to the form and to the records of the company.

(e) The data used to make adjustments as required in (d) above shall be reconciled to the data required to calculate the anticipated loss ratio as prescribed.

(f) If a carrier provides a quote to a policyholder or prospective policyholder, where an alternative design exists with premium savings that are greater than the anticipated out of pocket expenses, the carrier shall disclose the availability of this policy alternative. Deductibles, co-insurance and elimination periods are examples of benefit designs that shall be considered in calculating this difference. Variations in co-pays shall not be considered due to uncertainty with regard to utilization.

(g) Pursuant to (f) above, this policy alternative shall be made available on a guaranteed issue basis for renewal quotes.

(h) The carrier shall provide written notice to individuals in the event that:

(1) The carrier declines to offer coverage as applied for;

(2) The carrier makes an offer for coverage similar to any offering of the New Hampshire Health Plan pursuant to RSA 415:18, but at a premium rate that is greater than the New Hampshire Health Plan's premium rate; or

(3) The carrier provides a renewal quote for coverage similar to any offering of the New Hampshire Health Plan pursuant to RSA 415:18, but at a premium rate that is greater than the New Hampshire Health Plan's premium rate;

(i) The notice shall specify:

(1) That the person may be able to purchase health insurance from the New Hampshire Health Plan pursuant to RSA 415:18 or the federally qualified high risk pool pursuant to RSA 404-G:5-g; and

(2) Contact information for the New Hampshire Health Plan pursuant to RSA 415:18 and the federally qualified high risk pool pursuant to RSA 404-G:5-g.

N.H. Admin. Code § Ins 4102.06

#9690, eff 4-9-10; ss by #9938, eff 6-10-11; ss by #10212, eff 11-1-12 (from Ins 4103.09 )

The amended version of this section by New Hampshire Register Volume 39, Number 24, eff.6/10/2019 is not yet available.