Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-13 - Additional rate filing requirements

Current through July 10, 2024
(a) All rate
			 filings for small group health insurance providing coverage of the types
			 specified in Connecticut General Statutes Section 38a-469 (1), (2), (4), (11)
			 and (12) shall include:
(1) A demonstration
			 that the experience data submitted is consistent with the most recent financial
			 statement filed by the insurer with the Department pursuant to section 38a-53a
			 of the Connecticut General Statutes.
(2) Utilization trend by broad service
			 category, including utilization data.
(3) Impact of cost sharing leverage on
			 trend.
(4) Medical technology
			 trend.
(5) Benefit buy-down
			 analysis and impact on trend.
(6)
			 Cost of each new benefit mandate or requirement due to a change in state or
			 federal law, separately identified, from the experience period to the rating
			 period.
(7) Unit cost trend by
			 broad service category, including actual unit cost data and impact of provider
			 contract changes from experience period to rating period (medical and
			 prescription drug separately).
(8)
			 An annual certification of compliance with mental health parity Any insurer
			 that offers a plan that includes a cost share for medical expense at a lower
			 level than the mental health cost share shall include a demonstration that the
			 copayment is in compliance with mental health parity.
(9) A certification and demonstration that
			 any substitution of a non-dollar limit on an essential health benefit as
			 permitted by the PPACA is actuarially justified.
(10) A comparison of the proposed retention
			 charge in the filing to the most recently filed financial statement for the
			 insurer for which this filing is being made.
(11) Monthly historical experience including
			 earned premium, paid claims, incurred claims, membership, actual loss ratios
			 and expected loss ratios shall be provided for the most recent two (2)
			 years.
(12) The current capital and
			 surplus for the insurer for which this filing is being made.
(13) For filings subject to the PPACA, a
			 demonstration that the rate increase requested in this filing will generate an
			 expected medical loss ratio, for rebate purposes, that is consistent with the
			 medical loss ratio prescribed by the federal law for individual health
			 insurance.
(14) For filings subject
			 to the PPACA, the Uniform Rate Review Template (URRT), the Part III Actuarial
			 Memorandum, and the Health Insurance Oversight System rate tables. The Health
			 Insurance Oversight System rate tables shall be filed in a portable document
			 format. Insurers shall also provide a summary of benefits for each plan design
			 along with the federal Department of Health and Human Services' Actuarial Value
			 Calculator output that confirms compliance with the corresponding metal tier
			 set forth in the PPACA. The Health Insurance Oversight System plan ID and the
			 corresponding plan name on the summary of benefits for each plan shall be
			 indicated.