N.H. Admin. Code § Ins 4103.07

Current through Register No. 50, December 12, 2024

Section Ins 4103.07 - Rate Filing Standards

(a) Carriers shall calculate a market rate in accordance with the following:

(1) The calculation shall reflect the carrier's experience for all the products it sells and maintains in the small group health insurance market;

(2) Plan relativity factors that are used to modify the carrier's experience to a common market rate shall be the same factors that were used to calculate the health coverage plan rates during the experience period;

(3) The market rate shall be normalized for the average plan relativity factor; and

(4) Other assumptions used by the carrier in the calculation of the market rate shall be specified.

(b) The carrier shall calculate health coverage plan rates for the coverages it will offer from the market rate. The carrier shall provide plan relativity factors used to calculate the health coverage plan rates from the market rate. Any changes to the health coverage plan rates from the previously approved set of plan relativity factors shall be highlighted and the basis for the same shall be documented.

(c) Carriers shall calculate premium rates for each small employer from the health coverage plan rate through the application of factors for allowable case characteristics as follows:

(1) Carriers electing to use age as an allowable case characteristic shall comply with the following:

a. Tabulations by age shall be made using the age brackets delineated in RSA 420-G:4, I. (e)(2); and

b. Acceptable tabulation methods shall include:

1. Actual enrollment and ages of all covered persons;

2. Actual enrollment, ages of all enrolled employees and the tier to which they enrolled;

3. Estimated enrollment and ages of all covered persons; and

4. Estimated enrollment, ages of all enrolled persons and the tier to which they are assumed to enroll;

(2) Carriers electing to use group size as an allowable case characteristic shall comply with the following:

a. Variations in group size shall be based on the number of enrolled employees in all of the plans offered by the small employer carrier to the small employer's employees; and

b. Carriers may estimate the number of enrolled employees as long as the estimation methods used are uniform for all small employers;

(3) Carriers electing to use the type of industry in which the small employer is engaged shall apply industry variations uniformly for all small employers; and

(4) The total variation attributable to allowable case characteristics shall be subject to the following standards:

a. The ratio of the following calculation shall not exceed 3.5:

1. The largest premium rate obtainable from the application of the allowable case characteristics for any small employer group having no covered persons or enrolled employees less than 19 years old; and

2. The smallest premium rate obtainable from the application of the allowable case characteristics for any small employer group having no covered persons or enrolled employees less than 19 years old.

(d) All submissions shall:

(1) Include an actuarial certification and an actuarial memorandum, consisting of the sections prescribed herein;

(2) Be provided as electronic documents, in formats as prescribed herein; and

(3) Be attached to the SERFF filing under the supporting documentation tab with the components prescribed herein.

(e) The actuarial memorandum shall include a component labeled "Public Information" that contains a Microsoft Excel or compatible workbook that includes:

(1) A worksheet named "Cover Sheet" that includes the following information:

a. Contact information;

b. A statement indicating that the filing includes all of the carriers small group health insurance rates, or an explanation as to why it does not; and

c. A statement indicating whether the carrier utilizes list billing, and if so, a description of the groups being list billed;

(2) A worksheet named "Proposed Rate Change and Enrollment by Health Coverage Plan" that includes the following information for each health coverage plan:

a. Plan codes or suitable plan identifier;

b. The number of expected or enrolled members, subscribers and groups;

c. The number of expected or enrolled members, subscribers and groups that will be impacted by the proposed rate change; and

d. The proposed health coverage plan rate;

(3) A worksheet named "Plan Design and Plan Relativities" that includes the following information:

a. Carrier plan code or name;

b. PCP office visit copay;

c. Specialist office visit copay;

d. Emergency department copay;

e. Outpatient surgery copay;

f. In-network single deductible;

g. In-network coinsurance;

h. In-network single out-of-pocket maximum;

i. Indication if the deductible applies to all medical services;

j. Services that deductible does not apply to;

k. Indication if the deductible applies to pharmacy services;

l. Indication if preventive services are covered in full;

m. Indication if the health coverage plan covers mental health and substance services;

n. Indication if the health coverage plan has a tiered network component;

o. Retail pharmacy single deductible generic;

p. Retail pharmacy single deductible brand formulary;

q. Retail pharmacy single deductible brand non-formulary;

r. Retail pharmacy copay generic;

s. Retail pharmacy copay brand formulary;

t. Retail pharmacy copay brand non-formulary;

u. Plan relativity factors for proposed rates;

v. Policy form number;

w. Indication if the health coverage plan is open or closed;

x. Indication if the health coverage plan is grandfathered or non-grandfathered by federal definition;

y. Renewability of the health coverage plan;

z. General marketing method;

aa. Issue age limits; and

ab. Indication if the health coverage plan is new;

(4) A worksheet named "Experience Used in the Rate Development" that includes a brief description of the source for the experience data and PMPM claims information for:

a. Inpatient facility;

b. Outpatient facility;

c. Professional services;

d. Prescription drugs;

e. Capitation arrangements;

f. Other provider payments; and

g. Other;

(5) A worksheet named "Administrative Charges" that includes administrative charges as PMPM amounts;

(6) A worksheet named "Retention Charges" that includes information for retention charges segmented by:

a. Administrative costs;

b. Investment income credits;

c. Contributions to surplus or profit; and

d. Other;

(7) A worksheet named "Illustrative Rates" that delineates the final rate for 2 hypothetical groups;

(8) A worksheet named "Summary of Rating Factors" that provides information regarding the carrier's utilization of allowable rating factors;

(9) A worksheet named "Health Coverage Plan Rate PMPM Development for Standard Health Coverage Plan" that delineates how the health coverage plan rate is calculated for prescribed standard plans including the following information:

a. PMPM experience data;

b. Annual trend factor;

c. Months of trend;

d. Trend adjustments; and

e. PMPM retention; and

(10) A worksheet named "Medical Loss Ratio Exhibit Small Group Market" that includes documentation regarding the calculation of the anticipated loss ratio with the following information:

a. Member months;

b. Incurred claims;

c. Earned premium;

d. Quality improvement expenses; and

e. Earned premium adjustments.

(f) The actuarial memorandum shall include a component on the supporting documentation tab labeled "Supporting Public Information" with an attached PDF document that includes:

(1) An exhibit titled "Discussion of Credibility" that includes references to the sources for experience data, limitation on using plan specific experience and any explanation for experience adjustments;

(2) An exhibit titled "Illustrative Rates" that delineates the rate development for 2 hypothetical groups;

(3) An exhibit titled "Rating Factors" that includes rate factor tables for each rating factor;

(4) An exhibit titled "Expected Distribution of Rating Factors" that includes information delineating the expected distribution of membership by allowable rating factors with tier and conversion factors; and

(5) An exhibit titled "Description of Methodology for the Projected Medical Loss Ratio" that includes a discussion of data sources and pricing assumptions used to calculate the anticipated loss ratio.

(g) The actuarial memorandum shall include a component on the supporting documentation tab labeled "Confidential Information" that contains a Microsoft Excel or compatible workbook that includes a worksheet named "Detail on Final Trend Assumptions" with trend assumptions segmented by:

(1) Service categories, including:

a. Inpatient facility;

b. Outpatient facility;

c. Professional services;

d. Prescription drugs;

e. Other; and

(2) Changes in:

a. Unit cost; and

b. Utilization.

(h) The actuarial memorandum shall include a component on the supporting documentation tab labeled "Supporting Confidential Information" with an attached PDF document that includes:

(1) An exhibit titled "Description of Trend Development" that includes an explanation of the process used to develop trend assumptions; and

(2) An exhibit titled "Supporting Schedules for Trend Development" that includes documentation and other data to support the trend assumptions.

(i) Actuarial memoranda for rate revisions shall modify the worksheets required above as follows:

(1) The worksheet named "Cover Sheet" shall include the following additional information:

a. A statement certifying that there have been no changes to rating methodology since the most recently approved filing or a brief description of any such proposed changes; and

b. A statement certifying that there have been no benefit changes to any of the plans for which rates are being revised or a description of those benefit changes;

(2) The worksheet named "Proposed Rate Change and Enrollment by Health Coverage Plan" shall include the following additional information:

a. PMPM health coverage plan rate in effect 12 months prior to the proposed rate effective date; and

b. PMPM health coverage plan from the most recently approved filing;

(3) The worksheet named "Plan Design and Plan Relativities" shall include:

a. Plan relativities for coverage in effect on the rate effective date one year prior to the rate filing effective date; and

b. Supporting documentation for plan relativity factor changes that exceed 5%;

(4) The worksheet named "Detail Final Trend Assumptions" shall include the total annualized trend assumption from the most recently approved rate filing;

(5) The worksheet named "Administrative Charges" shall include:

a. The administrative charges used for coverages in effect on the rate effective date one year prior to the rate filing effective date; and

b. The administrative charges from the carrier's most recently approved filing;

(6) The worksheet named "Retention Charges" shall include:

a. The retention charges used for coverages in effect on the rate effective date one year prior to the rate filing effective date; and

b. The retention charges from the carrier's most recently approved filing;

(7) The worksheet named "Summary of Rating Factors" shall include an indication as to which of the rating factors have changed since the most recently approved rate filing;

(8) The worksheet named "Health Coverage Plan Rate PMPM Development for Standard Health Coverage" shall include:

a. The standard health coverage plan rates, PMPM, for coverages in effect on the rate effective date one year prior to the rate filing effective date; and

b. The standard health plan coverage rates, PMPM, which were approved in the carrier's most recently approved filing; and

(9) The worksheet named "Medical Loss Ratio Exhibit Small Group Market" shall include the historical medical loss ratio for the 3 complete calendar years prior to the rate effective date.

(j) Actuarial memoranda for rate revisions shall include a component titled "Additional Required Public Information for Rate Revisions" that contains a Microsoft Excel or compatible workbook with the following:

(1) A worksheet named "History of Rate Changes" that summarizes rate filings the carrier made over the prior 3 years including:

a. The rate effective date;

b. The average, annual proposed rate change; and

c. The average, annual approved rate change;

(2) A worksheet named "Distribution of Rate Changes" that includes the number of enrolled members, subscribers and groups that will be impacted by the proposed change segmented by the anticipated rate change;

(3) A worksheet named "Components of Average Proposed Rate Change" that includes the average rate change attributable to rate changes in:

a. Utilization;

b. Unit costs;

c. Retention;

d. Benefit changes required by law;

e. Other benefit changes;

f. Over or under statement of prior rates; and

g. Other.

(k) The actuarial memorandum for rate revisions shall include a component on the supporting documentation tab titled "Supporting Documentation for the Additional Required Public Information for Rate Revisions" with a PDF document titled "Description of Rating Factors" that includes supporting documentation for any proposed changes to the rating factors.

(l) Carriers shall submit a complete filing, at least annually, that includes all of the documentation required for rate revisions even if no changes in rates are being proposed to demonstrate that the continued use of the previously approved rates is appropriate.

(m) All submissions shall include an actuarial certification provided as a PDF document attached to the supporting documentation tab under the public information component with the following statements:

(1) A statement indicating that the filing conforms to generally accepted actuarial principals;

(2) A statement that the entire filing is in compliance with all applicable laws and rules;

(3) A statement that the premiums are not inadequate, excessive, unfairly discriminatory, or unreasonable in relation to the benefits;

(4) A statement that variations in health coverage plan rates:

a. Shall not exceed the maximum possible difference in benefits unless they are based on the following:

1. Expected utilization differences attributable to plan design;

2. Expected administrative cost differences attributable to plan design; and

3. Provider reimbursement variances attributable to plan design;

b. Do not vary based on the health status/morbidity or other demographics of the population electing the varying plans;

(5) A statement indicating that premium rates are calculated from health coverage plan rates and that premium rates vary from health coverage plan rates using only allowable rating factors;

(6) A statement that benefits are neither excluded nor vary by any of the allowable rating factors; and

(7) A statement indicating that the health plan coverages for which rates are being filed are being actively marketed and are available to both new issues and renewing policyholders.

(n) Carriers shall make an annual filing for rates. Carriers shall file rates each year on or before the uniform filing date established by the department, consistent with annual guidance from the Center for Medicare and Medicaid Services ("CMS"), for the coming calendar year. For rates subject to 45 CFR Part 154, carriers shall, in addition to filing with the department, make all filings required with CMS under federal regulations. Final approved rates for all small group market filings shall be available for public review no later than the start of the annual open enrollment period set by the U.S. Department of Health and Human Services pursuant to 42 U.S.C. 1803 l(c)(6)(B).

(o) In addition to the required annual rate filing, carriers may make interim filings no more than quarterly. Rate effective dates shall begin on the first day of each quarter. Rates for interim quarterly filings shall be available for public review on the rate effective date.

(p) Upon issuance or renewal of a policy, the rates for that policy shall be guaranteed to the policyholder, and may not change, for 12 months from issue or renewal.

(q) In accordance with RSA 91-A:5, IV, the department shall maintain the confidentiality of the commercial and proprietary trend assumptions and supporting documentation that is required to be submitted under Ins 4103.07(g) and (h).

N.H. Admin. Code § Ins 4103.07

#9690, eff 4-9-10; ss by #9938, eff 6-10-11; ss by #10212, eff 11-1-12

Amended by Volume XXXV Number 32, Filed August 13, 2015, Proposed by #10880, Effective 7/10/2015, Expires7/10/2025.

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