Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 71 - Small Group Health Benefit Plans* › Rule 191-71.6 - Restrictions Relating to Premium Rates

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
a. A
				small employer carrier shall develop a separate rate manual for each class of
				business. Base premium rates and new business premium rates charged to small
				employers by the small employer carrier shall be computed solely from the
				applicable rate manual developed pursuant to this rule. To the extent that a
				portion of the premium rates charged by a small employer carrier is based on
				the carrier's discretion, the manual shall specify the criteria and factors
				considered by the carrier in exercising such discretion.
b.
(1) A
				small employer carrier shall not modify the rating method used in the rate
				manual for a class of business until the change has been approved as provided
				in this paragraph. The commissioner may approve a change to a rating method if
				the commissioner finds that the change is reasonable, actuarially appropriate,
				and consistent with the purpose of Iowa Code chapter 513B and this
				chapter.
(2) A carrier may modify
				the rating method for a class of business only with prior approval of the
				commissioner. A carrier requesting to change the rating method for a class of
				business shall make a filing with the commissioner at least 30 days prior to
				the proposed date of the change. The filing shall contain at least the
				following information:
1. The reasons the
				change in rating method is being requested;
2. A complete description of each of the
				proposed modifications to the rating method;
3. A description of how the change in rating
				method would affect the premium rates currently charged to small employers in
				the class of business, including an estimate from a qualified actuary of the
				number of groups or individuals (and a description of the types of groups or
				individuals) whose premium rates may change by more than 10 percent due to the
				proposed change in rating method (not generally including increases in premium
				rates applicable to all small employers in health insurance
				coverage);
4. A certification from
				a qualified actuary that the new rating method would be based on objective and
				credible data and would be actuarially sound and appropriate; and
5. A certification from a qualified actuary
				that the proposed change in rating method would not produce premium rates for
				small employers that would be in violation of Iowa Code section
				513B4..
(3) For the purpose of this rule,
				a change in rating method shall mean:
1. A
				change in the number of case characteristics used by a small employer carrier
				to determine premium rates for health insurance coverages in a class of
				business;
2. A change in the manner
				or procedures by which insureds are assigned into categories for the purpose of
				applying a case characteristic to determine premium rates for health insurance
				coverages in a class of business;
3. A change in the method of allocating
				expenses among health insurance coverages in a class of business; or
4. A change in a rating factor with respect
				to any case characteristic if the change would produce a change in premium for
				any small employer that exceeds 10 percent.
For the purpose of 71.6(1)
"b"
(3)"1" a change
				  in a rating factor shall mean the cumulative change, with respect to such
				  factor, considered over a 12-month period. If a small employer carrier changes
				  rating factors with respect to more than one case characteristic in a 12-month
				  period, the carrier shall consider the cumulative effect of all such changes in
				  applying the 10 percent test under paragraph 71.6(1)
"b"
(3)"1." A filing which has not previously been approved,
				  denied, or questioned is deemed approved on or after 30 days from receipt by
				  the division.