North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-06.1 - Regulation to Implement The Small Employer Health Insurance Availability Act › Section 45-06-06.1-05 - Restrictions relating to premium rates

Current through Supplement No. 393, July, 2024
1.
				This section applies only to a health benefit plan offered by a small employer
				who employed an average of at least two but not more than twenty-five eligible
				employees on business days during the preceding calendar year and who employs
				at least two employees on the first day of the plan year.
2.
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 subsection. 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 purposes of the Act 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 thirty days prior to the proposed date of
				the change. The filing shall contain at least the following information:
(a) The reasons the change in rating method
				is being requested;
(b) A complete
				description of each of the proposed modifications to the rating method;
(c) 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 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;
(d) 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
(e) 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 North Dakota Century Code section 26.1-36.3-04.
(3) For the purpose of this
				section a change in rating method means:
(a)
				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;
(b) 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;
(c)
				A change in the method of allocating expenses among health benefit plans in a
				class of business; or
(d)
1 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 ten percent.
2 For the purpose of item 1, a change in a
				rating factor shall mean the cumulative change with respect to such factor
				considered over a twelve-month period. If a small employer carrier changes
				rating factors with respect to more than one case characteristic in a
				twelve-month period, the carrier shall consider the cumulative effect of all
				such changes in applying the ten percent test under item 1.