Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 5 - Minimum Standards; Contract Guidelines › Part 15 - SMALL EMPLOYER HEALTH INSURANCE REFORM REGULATION › Section 365:10-5-155 - Restrictions relating to premium rates

Current through Vol. 41, No.
				  20, July 1, 2024
(a)
Separate rate manuals required.
(1) 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
				  365:10-5-155(a). 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.
(2)
Modification
				  of rating method requirements.
(A) 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 365:10-5-155(a)(2). 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 purposes of the Act and this
				  Part.
(B) A carrier may modify the
				  rating method for a class of business only with priorapproval 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 thirty (30) days
				  prior or the proposed date of the change. The filing shall contain at least the
				  following information:
(i) The reasons the
				  change in rating method is being requested;
(ii) A complete description of each of the
				  proposed modifications to the rating method;
(iii) 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 ten
				  percent (10%) due to the proposed change in rating method (not generally
				  including increases in premium rates applicable to all small employers in a
				  health benefit plan);
(iv) 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
(v) 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 36 O.S.Supp.1994, §6515.
(C) For the purpose of 365:10-5-155 a change
				  in rating method shall mean:
(i) A change in
				  the number of case characteristics used by a small employer carrier to
				  determine premium rates for health benefit plans in a class of
				  business;
(ii) 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
				  benefit plans in a class of business;
(iii) A change in the method of allocating
				  expenses among health benefit plans in a class of business; or
(iv)
A "ten percent charge in premium"
				  test.
(I) A change in rating factor
				  with respect to any case characteristic if the change would produce a change in
				  premium for any small employer that exceeds ten percent (10%).
(II) For the purpose of
				  365:10-5-155(a)(2)(C)(iv)(I), a change in a rating factor considered over a
				  twelve (12) month period. If a small employer carrier changes rating factors
				  with respect to more than one case characteristic in a twelve (12) month
				  period, the carrier shall consider the cumulative effect of all such changes in
				  applying the ten percent (10%) test under
				  365:10-5-155(a)(2)(C)(iv)(I).