reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 39.00 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 39.03 - Individual Annuity or Pure Endowment Contracts

Current through Register 1525, July 5, 2024
(1) Except as provided in 211 CMR 39.03(2)
			 and (3), the 1983 Table "a" is recognized and approved as an individual annuity
			 mortality table for valuation and, at the option of the company, may be used
			 for the purpose of determining the minimum standard of valuation for any
			 individual annuity or pure endowment contract issued on or after June,
			 1982.
(2) Except as provided in 211
			 CMR 39.03(3), either the 1983 Table "a" or the Annuity 2000 Mortality Table
			 shall be used for determining the minimum standard of valuation for any
			 individual annuity or pure endowment contract issued on or after December 19,
			 1996.
(3) Except as provided in 211
			 CMR 39.03(4), the Annuity 2000 Mortality Table shall be used for determining
			 the minimum standard of valuation for any individual annuity or pure endowment
			 contract issued on or after January 1, 2001.
(4) Except as provided in 211 CMR 39.03(5),
			 the 2012 IAR Mortality Table shall be used for determining the minimum standard
			 of valuation for any individual annuity or pure endowment contract issued on or
			 after January 1, 2016.
(5) The 1983
			 Table "a" without projection is to be used for determining the minimum
			 standards of valuation for an individual annuity or pure endowment contract
			 issued on or after January 1, 1998, solely when the contract is based on life
			 contingencies and is issued to fund periodic benefits arising from:
(a) Settlements of various forms of claims
			 pertaining to court settlements or out of court settlements from tort
			 actions;
(b) Settlements involving
			 similar actions such as workers' compensation claims; or
(c) Settlements of long term disability
			 claims where a temporary or life annuity has been used in
lieu
of continuing disability payments.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 39.00 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 39.04 - Application of the 2012 IAR Mortality Table

Current through Register 1525, July 5, 2024
In using the 2012 IAR Mortality Table, the mortality rate for a
				person age x in year (2012 + n) is calculated as follows:
Click
				here to view image
The resulting
				qx2012+n shall be rounded to
				three decimal places per 1,000,
e.g
., 0.741 deaths per 1,000.
				Also, the rounding shall occur according to the formula above, starting at the
				2012 period table rate.
For example, for a male age 30,
				qx2012 = 0.741.
qx2013 =
				0.741 * (1 - 0.010) ^ 1 = 0.73359, which is rounded to 0.734.
q 
				2014 = 0.741 * (1 - 0.010) ^ 2 =
				0.7262541, which is rounded to 0.726.
A method leading to incorrect rounding would be to calculate
				qx2014 as
				qx2013 * (1 - 0.010), or
				0.734 * 0.99 = 0.727. It is incorrect to use the already rounded
				qx2013 to calculate
				qx2014.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 39.00 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 39.05 - Group Annuity or Pure Endowment Contracts

Current through Register 1525, July 5, 2024
(1)
			 Except as provided in 211 CMR 39.05(2) and (3), the 1983 GAM Table, the 1983
			 Table "a" and the 1994 GAR Table are recognized and approved as group annuity
			 mortality tables for valuation and, at the option of the company, any one of
			 these tables may be used for purposes of valuation for an annuity or pure
			 endowment purchased on or after June, 1982 under a group annuity or pure
			 endowment contract.
(2) Except as
			 provided in 211 CMR 39.05(3), either the 1983 GAM Table or the 1994 GAR Table
			 shall be used for determining the minimum standard of valuation for any annuity
			 or pure endowment purchased on or after December 19, 1996 under a group annuity
			 or pure endowment contract.
(3) The
			 1994 GAR Table shall be used for determining the minimum standard of valuation
			 for any annuity or pure endowment purchased on or after January 1, 2001 under a
			 group annuity or pure endowment contract.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 39.00 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 39.06 - Application of the 1994 GAR Table

Current through Register 1525, July 5, 2024
In using the 1994 GAR Table, the mortality rate for a person
				age x in year (1994 + n) is calculated as follows:
Click to view
				image
where the
				qx1994 and
				AAxs are as specified in the 1994 GAR
				Table.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 39.00 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 39.07 - Annuities Subject to M.G.L. c. 175, Section 120F

Current through Register 1525, July 5, 2024
The annuity reserve requirements of M.G.L. c. 175, § 9,
				subsections 2(a) and (b), apply to the group and individual annuity and pure
				endowment contracts that are subject to the requirements of M.G.L. c.175,
				§ 120F. In complying with those reserve requirements, companies shall
				apply the applicable mortality tables specified in
				211 CMR
				39.03 through
				39.05
				or such other mortality tables as may be permitted under law, modified as
				appropriate to reflect a gender neutral or gender blended
				basis.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 39.00 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 39.08 - Severability

Current through Register 1525, July 5, 2024
If any provision of
				211 CMR 39.00 or its
				application to any person or circumstances is for any reason held to be
				invalid, the remainder of
				211 CMR 39.00 and the
				application of its provisions to other persons or circumstances shall not be
				affected.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.01 - Purpose

Current through Register 1525, July 5, 2024
(1) In accordance with M.G.L. c. 176D, §
			 11 and c. 175, § 110E it is the intent of
			 211 CMR 40.00 to assure
			 truthful and adequate disclosure of all material and relevant information and
			 to identify certain misleading or misrepresentative practices in the marketing
			 of health plans under M.G.L. c. 176D, § 3. This purpose is intended to be
			 accomplished by the establishment of, and adherence to, certain minimum
			 standards and guidelines of conduct in the advertising and marketing of insured
			 health plans in a manner which prevents unfair competition among carriers and
			 is conducive to the accurate presentation and description to the
			 insurance-buying public of such plans offered through marketing
			 methods.
(2) In general, it shall
			 be deemed misleading to solicit an offer to contract for health plans without a
			 clear and conspicuous disclosure of the following:
(a) The extent and nature of the coverage
			 offered.
(b) The extent to which
			 the coverage meets the potential risk.
(c) The cost of the coverage.
It is, therefore, a misrepresentation to solicit an offer to
				contract for an insured health plan without disclosing the above
				data.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.02 - Applicability

Current through Register 1525, July 5, 2024
(1)
								211 CMR 40.00 shall apply to
			 any marketing method for any insured health plan that is intended for
			 presentation, distribution or dissemination in Massachusetts when made or on
			 behalf of any person as defined herein. A marketing method originating outside
			 Massachusetts, but which may reasonably be expected to be seen or heard in this
			 state, must comply with
			 211 CMR 40.00 or prominently
			 set forth the following disclaimer: "This solicitation is not available to
			 residents of Massachusetts."
(2)
			 Every carrier, as herein defined, shall establish and at all times maintain a
			 system of control over the content, form and method of dissemination of all
			 marketing methods of its insured health plans. All marketing methods shall be
			 the responsibility of the carrier whose insured health plans are so
			 marketed.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.04 - Identity of Insurer

Current through Register 1525, July 5, 2024
(1) Failure to
			 clearly identify the name of the carrier and, where practicable, the form
			 number on all marketing materials will be considered misleading and is
			 therefore prohibited. A marketing method shall not use a trade name, or
			 insurance group designation, name of the parent company or the insurer, name of
			 a particular division of the insurer, service mark, slogan, symbol or other
			 device which without disclosing the name of the actual insurer would have the
			 capacity and tendency to mislead or deceive as to the true identity of the
			 insurer and therefore be prohibited.
(2) It shall be considered misleading and
			 therefore prohibited for a marketing method to use any combination of words,
			 symbols, or physical materials which by their content, phraseology, shape,
			 color or other characteristics are so similar to combination of words, symbols,
			 or physical materials used by agencies of Massachusetts or of the Federal
			 Government, or otherwise appear to be of such a nature that it tends to confuse
			 or mislead prospective insureds into believing that the solicitation is in some
			 manner connected with an agency of the municipal, state, or Federal
			 Government.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.05 - Method of Disclosure or Required Information

Current through Register 1525, July 5, 2024
All information required to be disclosed by
				211 CMR 40.00 shall be
				presented conspicuously and in close conjunction with the statements to which
				such information relates or under appropriate captions of such prominence that
				it shall not be minimized, rendered obscure or presented in an ambiguous
				fashion or disclosed in any manner so as to be confusing or
				misleading.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.06 - Form and Content of Marketing Method

Current through Register 1525, July 5, 2024
(1) A marketing method for an insured health
			 plan shall be sufficiently complete and clear to avoid deception or the
			 capacity or tendency to mislead or deceive. Whether a marketing method has a
			 capacity or tendency to mislead or deceive shall be determined by the
			 Commissioner of Insurance from the overall impression that the marketing method
			 may be reasonably expected to create upon a person of average education or
			 intelligence, within the segment of the public to which it is
			 directed.
(2) Marketing methods
			 shall be truthful and not misleading in fact or in implication. Persons using
			 words or phrases, whose meanings are only understood by implication or by
			 familiarity with insurance terminology, shall be considered misleading. In
			 determining whether a marketing method has the capacity or tendency to mislead,
			 the Commissioner of Insurance may consider as misleading the failure to
			 disclose to a purchaser or a prospective purchaser any fact, the disclosure of
			 which may have influenced the purchaser or prospective purchaser not to enter
			 into the transaction.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.08 - Renewability, Cancel ability and Termination

Current through Register 1525, July 5, 2024
When a marketing method refers to either a dollar amount or a
				period of time for which any benefit is payable, or the cost of the policy, or
				specific policy benefit, or the loss for which such benefit is payable, it
				shall disclose the provisions relating to renewability, cancel ability and
				termination and any modification of reasons, in a manner which shall not
				minimize or render obscure the qualifying conditions or it shall be considered
				misleading, and therefore prohibited.
In this regard where there is a guarantee of renewability or
				premium which is conditional either on renewal of all such policies or premium
				adjustment on all such policies it will be considered misleading unless the
				marketing method clearly and conspicuously discloses that the insurer has the
				right to non-renew or to change premium levels at its choice and without
				specific approval of any state authority.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.09 - Testimonials or Endorsements by Third Parties

Current through Register 1525, July 5, 2024
(1) Testimonials used in marketing methods
			 must be genuine, represent the current opinion of the author, be applicable to
			 the policy marketed and be accurately reproduced or it shall be considered
			 misleading, and therefore prohibited. The carrier, in using a testimonial,
			 makes as its own all of the statements contained therein, and the marketing
			 method, including such statement, is subject to all the provisions of
			 211 CMR 40.00.
(2) If the person making a testimonial, an
			 endorsement or an appraisal has a financial interest in the carrier or a
			 related entity as a stockholder, director, officer, employee, or otherwise,
			 such fact shall be disclosed in the marketing method or it shall be considered
			 misleading, and therefore prohibited. If a person is compensated for making a
			 testimonial, endorsement or appraisal, such fact shall be disclosed in the
			 marketing method by language substantially as follows: "Paid endorsement." 211
			 CMR 40.09(2) does not require disclosure of union "scale" wages required by
			 union rules if the payment is actually for such "scale" for TV or radio
			 performances. The payment of substantial amounts, directly or indirectly for
			 "travel and entertainment" for filming or recording of TV or radio
			 advertisements removes the filming or recording from the category of an
			 unsolicited testimonial and requires disclosure of such compensation.
(3) A marketing method shall not state or
			 imply that a carrier or a policy has been approved or endorsed by any
			 individual, group of individuals, society, association or other organizations,
			 unless such is the fact, and unless any proprietary or other financial
			 relationship between an organization and the carrier is disclosed, or it shall
			 be considered misleading, and therefore prohibited. If the entity making the
			 endorsement or testimonial has been formed by the carrier or is owned or
			 controlled by the carrier or the person or persons who own or control the
			 carrier, such fact shall be disclosed in the marketing method or it shall be
			 considered misleading, and therefore prohibited.
(4) In order to assure compliance when a
			 testimonial refers to benefits received under a policy, the specific claim
			 data, including claim number, data of loss, and other pertinent information
			 shall be retained by the carrier for inspection for a period of four years or
			 until the filing of the next regular report on examination of the carrier,
			 whichever is the longer period of time.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.10 - Use of Statistics in Marketing

Current through Register 1525, July 5, 2024
(1) A
			 marketing method using statistics of any type relating to a carrier, including
			 the dollar amounts of claims paid, the time within which claims are paid, or
			 the number of persons insured, shall be considered misleading, and therefore
			 prohibited, unless it identifies the sources of all statistics and accurately
			 reflects all of the relevant facts. A marketing method shall not imply that
			 statistics are derived from the policy advertised or marketed unless such is
			 the fact, and when applicable to other policies shall specifically so state the
			 policies to which it refers.
(2) A
			 marketing method shall not represent or imply that claim settlements by the
			 insurer are "liberal" or "generous" or use words of similar import, that claims
			 settlements are or will be beyond the actual terms of the contract, or shall
			 not portray an unusual amount paid for a unique claim for the policy
			 marketed.
(3) The source of any
			 statistics used in a marketing method shall be identified in such advertisement
			 or marketing method or it shall be considered misleading, and therefore
			 prohibited.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.11 - Identification of Plan or Comparison Among Plans

Current through Register 1525, July 5, 2024
(1) When a marketing method refers to a
			 choice of benefit amounts, it shall be considered misleading, and therefore
			 prohibited, if it does not disclose that the amount of benefits provided to the
			 consumer depends upon the plan selected by the consumer and that the premium
			 will vary with the amount of the benefits selected.
(2) When a marketing method refers to various
			 benefits which may be contained in two or more policies (other than group
			 master policies), it shall be considered misleading, and therefore prohibited,
			 unless it discloses that such benefits are provided only through a combination
			 of such policies.
(3) When a
			 marketing method makes comparisons between insured health plans, it shall be
			 considered to be misleading, and therefore prohibited, if it makes unfair or
			 incomplete comparisons of policy benefits, compares noncomparable aspects of
			 policies of other carriers, or disparages competitors, their policies, their
			 services, or their business methods of marketing insured health
			 plans.
(4) A marketing method for a
			 particular policy shall not state or imply that prospective insureds become
			 group or quasi-group members covered under a group policy and as such enjoy
			 special rates or underwriting privileges, unless such is the fact or it shall
			 be considered misleading, and therefore prohibited.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.12 - Introductory, Initial or Special Offers

Current through Register 1525, July 5, 2024
(1) A
			 marketing method for any individual insured health plan shall not directly, or
			 by implication, represent that a contract or combination of contracts is an
			 introductory, initial or special offer, or that applicants will receive
			 substantial advantages not available at a later date, or that the offer is
			 available only to a specified group of individuals, unless such is the fact or
			 it shall be considered misleading, and therefore prohibited. A marketing method
			 shall not contain phrases describing an enrollment period as "special,"
			 "limited," or similar words or phrases when the insurer used such enrollment
			 periods as the usual method of advertising or marketing accident and sickness
			 insurance or it shall be considered misleading, and therefore
			 prohibited.
(2)
								211 CMR 40.00 prohibits any
			 statement or implication to the effect that only a specific number of policies
			 will be sold, or that a time is fixed for the discontinuance of the sale of the
			 particular policy marketed because of special advantages available in the
			 policy unless such is fact.
(3) A
			 marketing method shall not utilize an initial premium rate which is less than
			 that premium rate which would be charged by making a uniform prorating of the
			 annual premium or it shall be considered misleading, and therefore
			 prohibited.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.13 - Form and Content of Policy Applications

Current through Register 1525, July 5, 2024
When a person uses an application form to be completed by the
				applicant as an offer to contract for an insured health plan, such application
				form shall contain statements disclosing to the applicant the nature of the
				policy offered for sale. In complying with 211 CMR 40.13 the following
				guidelines as to the contents and applicability of disclosure requirements
				shall be used.
(1) If the advertised
			 or marketed policy contains a provision which allows the carrier to deny claims
			 for any loss, where the cause of such loss is in some manner traceable to a
			 condition existing prior to the effective date of the policy, the application
			 shall state clearly and unambiguously in negative terms the nature and extent
			 of that exclusion in accordance with guidelines spelled out in
			 211 CMR
			 40.07(3)(a).
(2) If the application is for a policy whose
			 benefits are subject to a waiting period either of the deductible kind,
e.g
. "fifth day for sickness" or of the one-time exclusionary
			 kind, "30 day" or "six months for certain conditions," the application must
			 disclose in negative terms the nature of such exclusion.
(3) The application must disclose for all
			 health policies whether or not and to what extent benefits are or are not
			 contingent upon hospital confinement.
(4) The application must disclose the premium
			 rate for the policy being solicited.
(5) The application must disclose clearly and
			 unambiguously the terms of renewability and premium guarantee, if
			 any.
(6) At the completion of the
			 above required statements of disclosure space shall be made for the applicant's
			 signature acknowledging understanding of such disclosures.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.14 - File of All Marketing Methods

Current through Register 1525, July 5, 2024
In order to assure compliance under
				211 CMR 40.00, each carrier
				shall maintain at its home or principal office a complete file containing every
				printed, published or prepared marketing method of its individual policies and
				typical printed, published or prepared marketing methods of its blanket,
				franchise and group policies hereafter disseminated in this or any other state
				whether or not licensed in such other state, with a notation attached to each
				such marketing method that shall indicate the manner and extent of distribution
				and the form number of any policy advertised or marketed. Such file shall be
				subject to regular and periodic inspection by the Division of Insurance. All
				such marketing methods shall be maintained in said file for a period of either
				four years or until the filing of the next regular report on examination of the
				carrier, whichever is the longer period of time.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.16 - Severability Provision

Current through Register 1525, July 5, 2024
If any section or portion of a section of
				211 CMR 40.00, or the
				applicability thereof, to any person or circumstance is held invalid by a
				court, the remainder of
				211 CMR 40.00, or the
				applicability of such provision, to other persons or circumstances, shall not
				be affected thereby.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.01 - Purpose, Scope and Authority

Current through Register 1525, July 5, 2024
211 CMR 41.00, promulgated
				pursuant to M.G.L. c. 176M and M.G.L. c. 30A, governs the form and content of
				rate and policy form filings, review, and hearing procedures for Closed
				Nongroup Health Plans and Closed Guaranteed Issue Health Plans as defined in
				211 CMR 41.00. In accordance
				with M.G.L. c. 176M, § 5(i), nothing in
				211 CMR 41.00 shall be
				construed to limit the Commissioner's authority to disapprove rates pursuant to
				M.G.L. chs. 175, 176A, 176B, 176G and 176I.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.03 - Geographic Regions for Area Rate Adjustments

Current through Register 1525, July 5, 2024
(1) A Carrier may establish an area rate
			 adjustment for each different geographic region designated in 211 CMR 41.03(2),
			 which must range from .80 to 1.20. If a Carrier chooses to establish area rate
			 adjustments, it shall apply the adjustments to every eligible individual within
			 each region.
(2) The regions of
			 Massachusetts described below are established for use in making area rate
			 adjustments. The regions are based on zip code groupings which refer to the
			 first three digits of the zip code for each eligible individual.
(a) 010 through 013;
(b) 014 through 016;
(c) 017 and 020;
(d) 018 through 019;
(e) 021 through 022 and 024;
(f) 023 and 027; and
(g) 025 through 026.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.04 - Pre-existing Condition Limitations and Waiting Periods

Current through Register 1525, July 5, 2024
(1) No Carrier may exclude any Eligible
			 Individual or Eligible Dependent from a Closed Guaranteed Issue Health Plan on
			 the basis of an actual or expected health condition of such person.
(2) No Carrier may modify the coverage of an
			 Eligible Individual or Eligible Dependent through riders or endorsements, or
			 otherwise restrict or exclude coverage for certain diseases or medical
			 conditions otherwise covered by a Closed Guaranteed Issue Health
			 Plan.
(3) For Eligible Dependents
			 added to a Closed Plan or a Closed Guaranteed Issue Health Plan, a Carrier may,
			 but is not required to, impose either a provision for a Pre-existing Condition
			 Limitation or a provision for a Waiting Period, provided that:
(a) The Pre-existing Condition Limitation or
			 Waiting Period does not limit or exclude coverage for a period beyond six
			 months following the Eligible Dependent's effective date of coverage.
(b) No Pre-existing Condition Limitation or
			 Waiting Period may apply to a Trade Act/Health Coverage Tax Credit-eligible
			 person.
(c) If a policy includes a
			 Waiting Period, emergency services shall be covered during the Waiting
			 Period.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.05 - Calculation of Adjusted Composite Rate

Current through Register 1525, July 5, 2024
(1) To
			 derive the Adjusted Composite Rate for each Closed Guaranteed Issue Health
			 Plan, Carriers shall adjust the Composite Rate to account for differences in
			 premiums among Carriers that are the result of geographic differences in the
			 cost of health care, the average age of eligible individuals enrolled in a
			 Carrier's Closed Guaranteed Issue Health Plan, and differences in benefit
			 levels as permitted by M.G.L. c. 176M, § 2(c)(4) or M.G.L. c. 176M, §
			 2(d).
(2)
Worksheet
. A Carrier shall use the worksheet contained
			 in
			 211 CMR
			 41.98:
Appendix A
to
			 calculate the Adjusted Composite Rate for each type of Closed Guaranteed Issue
			 Health Plan it offers. For all noted adjustments, Carriers shall submit
			 documentation reasonably necessary to substantiate the adjustments made,
			 including:
(a) A specific explanation, and
			 all calculations, of the method by which the Adjusted Composite Rate was
			 determined;
(b) A list of all
			 adjustments based upon age, geographic area, premium payment mode, and
			 enhancements or alternative benefits; and
(c) An explanation of the actuarial value and
			 actuarial basis for adjustments made for each age band, geographic area,
			 premium payment mode, and enhancements, or alternative benefits.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.06 - Content and Timing of Rate Filings

Current through Register 1525, July 5, 2024
(1)
General Instructions.
(a) A separate Rate Filing must be submitted
			 for each Closed Guaranteed Issue Health Plan, including separate filings for
			 Standard Benefits Plan or Enhanced Benefits Plans and any Alternative Benefits
			 Plan, and for each Closed Plan; provided that a Carrier with more than one
			 Closed Plan may combine Rate Filings for its Closed Plans if the plans'
			 benefits vary by no more than the following extent: any deductibles for the
			 combined plans do not vary by more than $1,000; any coinsurance percentage
			 amounts for the combined plans do not vary by more than 10%; and any copayments
			 (excluding for emergency room visits) for the combined plans do not vary by
			 more than $50; and, provided further, that a Rate Filing for a Closed Plan with
			 outpatient prescription drug benefits may not be combined with a Rate Filing
			 for a Closed Plan without outpatient prescription drug benefits, and a Rate
			 Filing for a Closed Plan with medical/surgical and hospital benefits may not be
			 combined with a Rate Filing for a Closed Plan with only hospital benefits. For
			 each plan, Carriers also shall submit data and documentation reasonably
			 necessary to substantiate all calculations and adjustments made. Carriers shall
			 comply with all applicable filing fee requirements for each Rate
			 Filing.
(b) A Carrier may establish
			 a premium rate adjustment based upon the age of an insured individual, the age
			 rate adjustment, which may range from 0.67 to 1.33. If a Carrier chooses to
			 establish age rate adjustments, the premium charge to every individual enrolled
			 in a Closed Guaranteed Issue Health Plan shall be subject to the applicable age
			 rate adjustment.
(c) Carriers shall
			 submit Rate Filings via SERFF no later than May 1st
			 of each year.
(d) All Rate Filings
			 must comply with the provisions of the rate and filing requirements of the
			 Carrier's licensing statutes which are not inconsistent with M.G.L. c. 176M and
			 211 CMR 41.00.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.07 - Annual Notice to Insureds

Current through Register 1525, July 5, 2024
(1) Annually, as of
			 May 1st, Carriers shall provide to the Division a
			 sample copy of the notice that describes all of the Carrier's health benefit
			 plans and corresponding premiums for which the insured is eligible under M.G.L.
			 c. 176J.
(a) The notice must be sent to
			 insureds at least at the time that Carriers send notice of premium rate
			 changes.
(b) The notice shall
			 include the following information:
1. A brief
			 description of the plans.
2. An
			 explanation of the premium for each plan. A Carrier may meet the requirement of
			 211 CMR 41.07(1) by including in the notice language that refers the insured to
			 resources where the information can be accessed, including but not limited to
			 an internet website. The term "internet website" shall include "intranet
			 website" and "electronic mail" or "e-mail". The Carrier shall provide free of
			 charge a paper copy of this information if the Subscriber requests such a paper
			 copy. The Carrier shall provide a toll-free telephone number for the Subscriber
			 to call with any questions or requests.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.08 - Discontinuing a Closed Guaranteed Issue Health Plan or a Closed Plan

Current through Register 1525, July 5, 2024
(1) A Carrier shall no longer offer, sell, or
			 deliver a Health Plan to any person to whom it does not have such an obligation
			 pursuant to an individual policy, contract or agreement with an employer or
			 through a trust or association.
(2)
			 Notwithstanding 211 CMR 41.08(1), a Closed Guaranteed Issue Health Plan or a
			 Closed Plan shall be subject to all requirements of
			 211 CMR
			 41.06.
(3) All Closed Guaranteed Issue Health Plans
			 and Closed Plans shall be renewable, unless such plans are
			 discontinued.
(4) A Carrier may
			 discontinue a Closed Guaranteed Issue Health Plan or a Closed Plan at the
			 discretion of the Commissioner. A request to discontinue a Closed Guaranteed
			 Issue Health Plan or a Closed Plan shall be submitted to the Commissioner in
			 writing at least 120 days prior to the date on which the Carrier proposes to
			 discontinue the Closed Guarantee Issue Health Plan or the Closed Plan, shall be
			 certified by an officer of the Carrier and shall include:
(a) A list, by marketed name and/or policy
			 form identification number, of each Closed Guaranteed Issue Health Plan or
			 Closed Plan that the Carrier proposes to discontinue, including the date by
			 which it proposes to discontinue each Closed Guaranteed Issue Health Plan or
			 Closed Plan;
(b) The number of
			 covered lives (Eligible Individuals and Eligible Dependents) in each Closed
			 Guaranteed Issue Health Plan or Closed Plan that the Carrier proposes to
			 discontinue;
(c) The written notice
			 the Carrier proposes to send to affected Eligible Individuals at least 90 days
			 prior to the date the Carrier proposes to discontinue the Closed Guaranteed
			 Issue Health Plan or Closed Plan, which shall state in clear and unambiguous
			 language:
1. The date on which the Carrier
			 will discontinue coverage in the plan;
2. The Minimum Creditable Coverage
			 requirements in the Commonwealth;
3. The ways an Eligible Individual may
			 purchase a health benefit plan through the Connector or directly from the
			 Carrier, if offering coverage in the market, or directly from any other Carrier
			 offering health benefit plans for individuals in the Commonwealth;
			 and
4. Information regarding open
			 enrollment as applies to individual health plans, as set forth in M.G.L. c.
			 176J, § 4.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.09 - Content and Timing of Policy Form Filings

Current through Register 1525, July 5, 2024
(1) Carriers shall submit to the Division
			 three copies of the policy, certificate of coverage or evidence of coverage for
			 each of its Closed Guaranteed Issue Health Plans and Closed Plans with the
			 associated Rate Filing for each plan submitted pursuant to
			 211 CMR
			 41.06. As part of the policy form filing for
			 each Closed Guaranteed Issue Health Plan, Carriers shall submit the applicable
			 application or enrollment form, replacement form and outline of coverage or
			 disclosure statement.
(2) Policy
			 forms for all Closed Guaranteed Issue Health Plans and Closed Plans must comply
			 with all applicable provisions in M.G.L. c. 176M and
			 211 CMR 41.00 and any other
			 applicable Massachusetts statutes and regulations, including
			 211 CMR 42.00,
			 43.00,
			 51.00 and
			 52.00, which are not
			 inconsistent with M.G.L. c. 176M and
			 211 CMR 41.00, as well as any
			 applicable federal statutes and regulations. Policy forms for Closed Guaranteed
			 Issue Health Plans and Closed Plans must include all benefits required under
			 the Carrier's licensing statutes.
(3) Policy forms for Standard Benefits Plans
			 must contain all benefits required to be included in the Standard Benefits
			 Plans approved by the Commissioner pursuant to M.G.L. c. 176M, § 2(c).
			 Policy forms for Closed Guaranteed Issue Health Plans with Enhanced Benefits
			 Plans must contain the benefits of the comparable Standard Benefits Plans and
			 must identify each additional benefit or lower cost-sharing requirement that
			 the Carrier proposes to include in the plans.
(4) Policy forms for Alternative Benefits
			 Plans must contain coverage for the same services and supplies as the Standard
			 Benefits Plans, except for the prescription drug benefit, but may include
			 higher cost-sharing requirements than the Standard Benefits Plans. All filings
			 of Alternative Benefits Plans must identify each benefit that is lower than or
			 each cost-sharing requirement that is higher than what is being offered in the
			 Carrier's Standard Benefits Plan or Enhanced Benefits Plan.
(5) Carriers shall comply with all form
			 filing fee requirements.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.10 - Review of Policy Forms and Rate Filings and Notification to Carriers

Current through Register 1525, July 5, 2024
(1)
Policy Forms
.
			 The Commissioner shall notify a Carrier if he or she determines that the policy
			 form filing submitted pursuant to
			 211 CMR
			 41.09 does not comply with applicable
			 Massachusetts laws and regulations or otherwise fails to comply with M.G.L. c.
			 176M or
			 211 CMR
			 41.09. Upon such notice, a Carrier shall
			 amend and resubmit its policy form filing for review within the time period
			 specified by the Commissioner.
(2)
Rate Filings for Closed Guaranteed Issue Health Plans.
(a) The Commissioner shall notify a Carrier
			 if he or she determines that the Rate Filing does not comply with
			 211 CMR 41.00, contains
			 discrepancies or inaccuracies, or otherwise is incomplete. Upon such notice, a
			 Carrier shall amend and resubmit its Rate Filing within the time period
			 specified by the Commissioner.
(b)
			 After the Commissioner has computed an Average Adjusted Composite Rate for each
			 type of Closed Guaranteed Issue Health Plan, and has calculated the standard
			 deviation for the submitted Adjusted Composite Rates, the Average Adjusted
			 Composite Rate and Standard Deviation will be final and will not be changed if
			 any Carrier's rates are modified as a result of further review by the
			 Commissioner or a Proceeding.
(c)
			 The Commissioner shall, no later than June 15th of
			 each year, issue to a Carrier his or her determination of whether the Carrier's
			 Rate Filing is subject to further review. The Rate Filing will be subject to
			 further review if the Commissioner determines that the Adjusted Composite Rate
			 filed by a Carrier exceeds the Average Adjusted Composite Rate for that type of
			 Closed Guaranteed Issue Health Plan by more than two Standard Deviations and
			 the proposed Adjusted Composite Rate also exceeds 110% of the Carrier's current
			 Adjusted Composite Rate for the plan.
(d) If the Commissioner issues a notice to a
			 Carrier by June 15th that its Rate Filing is not
			 subject to further review, the Carrier shall implement the filed rates the
			 following December 1st.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.11 - Further Review of Closed Guaranteed Issue Health Plan Rate Filing

Current through Register 1525, July 5, 2024
(1)
Amended Filing
.
			 A Carrier that is notified that its Rate Filing for a Closed Guaranteed Issue
			 Health Plan is subject to further review may, no later than 21 days following
			 that notice, submit an amended Rate Filing in which its rates for that plan
			 have been reduced by an amount to cause its Adjusted Composite Rate to be less
			 than the Average Adjusted Composite Rate plus two Standard Deviations. The
			 Carrier's amended Rate Filing shall then be reviewed in accordance with the
			 standards in
			 211 CMR 41.00.
(2)
Carrier's Submission of
			 Additional Evidence
. If a Carrier that is notified that its Rate
			 Filing for a Closed Guaranteed Issue Health Plan is subject to further review
			 does not submit an amended Rate Filing, such Carrier may, no later than 21 days
			 following that notice, submit additional evidence, including an Actuarial
			 Opinion and Memorandum, to show that:
(a) The
			 rate filed is reasonable in relation to the benefits provided; or
(b) Its Adjusted Composite Rate would not
			 have exceeded the Average Adjusted Composite Rate for that type of Closed
			 Guaranteed Issue Health Plan by more than two Standard Deviations if its
			 Adjusted Composite Rate had been further adjusted for the case mix of persons
			 insured in that Carrier's Nongroup Health Plans in operation as of August 15,
			 1996, whom the Carrier anticipates will be covered in its Closed Guaranteed
			 Issue Health Plan during the period of the proposed rates.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.12 - Hearing Request for Disapproved Closed Guaranteed Issue Health Plan Rate Filing

Current through Register 1525, July 5, 2024
(1) A Carrier whose proposed rate for a
			 Closed Guaranteed Issue Health Plan has been disapproved by the Commissioner
			 pursuant to
			 211
			 CMR 41.11(6)  may, within 21
			 days of the Commissioner's decision, submit a Hearing Request to the
			 Division.
(2)
Contents
. The Hearing Request constitutes the
			 Carrier's direct case in the Proceeding. The Hearing Request must consist of
			 sequentially numbered pages, must use any format previously prescribed by the
			 Presiding Officer or the Commissioner and must contain:
(a) A title stating the nature of the
			 Proceeding, and the complete name and address of the Party submitting the
			 request;
(b) The name and address
			 of counsel or other authorized representative as prescribed in
			 211 CMR
			 41.14(7);
(c) An executive summary describing, in
			 narrative form, the reasons for the Hearing Request, including a description of
			 errors the Carrier believes may have been made by the Commissioner in the
			 review process, a description of the grounds in support of the rate requested,
			 and the specific relief sought;
(d)
			 A copy of the Rate Filing;
(e) A
			 copy of all materials submitted as part of the further review;
(f) A copy of all written communications
			 between the Carrier and the Division as part of the review process;
(g) Identification of each witness on whose
			 testimony the Carrier intends to rely in support of its request for relief, and
			 identification of the subject matter of the witness' testimony, with sufficient
			 clarity to enable the Presiding Officer to determine his or her qualifications
			 to testify on that subject matter;
(h) The sworn written direct testimony of
			 each witness in narrative form, including all information and commentary
			 submitted in support of each issue the Carrier intends to raise in the
			 Proceeding;
(i) All additional
			 information, including data, statistics, schedules and exhibits which the
			 Carrier intends to present for consideration in the Proceeding and upon which
			 its recommendations are based; and
(j) Other information as prescribed from time
			 to time by the Commissioner or the Presiding Officer by order, decision or
			 bulletin.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 41.00 - Nongroup Health Insurance Rate And Policy Form Filings, Review, And Hearing Procedures Under M.g.l. C.176m › Section 41.13 - General Provisions Governing Rate Proceedings

Current through Register 1525, July 5, 2024
(1)
Filings
. All
			 papers relating to a Proceeding must be timely filed with the Docket Clerk,
			 Hearings and Appeals, at the Division's principal office during business hours.
			 For filings of papers other than Hearing Requests or Responsive Filings, an
			 original and one copy must be filed unless otherwise provided by the Presiding
			 Officer. Concurrently with filing papers, a Party shall serve a copy of the
			 papers on all Parties to the Proceeding by hand delivery, facsimile
			 transmission or electronic mail transmission promptly followed by first - class
			 postage pre-paid mail delivery, unless otherwise permitted by the Presiding
			 Officer. Failure to comply with 211 CMR 41.13(1) will be grounds for refusal by
			 the Presiding Officer to accept papers for filing.
(2)
Copies of Hearing Requests,
			 Responsive Filings and Revised Rate Filings
. Six copies of all
			 Hearing Requests, Responsive Filings and Revised Rate Filings must be
			 submitted, unless the Presiding Officer directs otherwise. Copies of text and
			 data included in the filings also must be submitted by electronic means in a
			 format determined by the Presiding Officer. Concurrently with filing, the
			 Carrier or Intervenor shall serve a copy to all other Parties, and shall serve
			 a copy on any person subsequently permitted to intervene in the Proceeding
			 within two days after issuance of an order granting the person permission to
			 intervene.
(3)
Timely
			 Filing
. Papers in a Proceeding must be filed within the specified
			 time limits. The date of filing will be determined as follows:
(a) Papers delivered by hand or by facsimile
			 during regular business hours will be deemed filed on that day.
(b) Papers delivered by hand or by facsimile
			 at other times will be deemed filed on the next business day.
(c) Papers mailed to the Division's principal
			 office will be deemed filed on the day the Division receives them.