North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE › Section 16 .0205 - DATA REQUIREMENTS FOR RATE REVISION SUBMISSION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) With
				respect to any individual accident and health insurance policy governed by G.S.
				58, Articles 1 through 64, for which an adjustment of premium rate is allowed
				by law, the insurer shall submit an actuarial memorandum describing and
				demonstrating the development of any requested premium rate revision. The
				actuarial memorandum shall contain a subsection identified as "Additional Data
				Requirements." The initial rate revision filing shall be submitted to the
				Department's Life and Health Division. An insurer shall submit all data
				required by this Rule within 45 days after the date that the initial rate
				revision filing is stamped received by the Division. Subsequent data
				submissions on incomplete initial rate revision filings shall be made directly
				to the Department's Actuarial Services Division within the 45 day period. The
				"Additional Data Requirements" subsection shall include:
(1) identification of the submitted data as
				North Carolina or countrywide and consistent use of this data identification
				throughout this Section;
(2)
				identification of all previously approved policy forms included in the rate
				revision submission, by North Carolina policy form number;
(3) the month, year, and percentage amount of
				all previous rate revisions;
(4)
				the month and year that the rate revision is scheduled to be implemented
				(hereinafter referred to as the "implementation date");
(5) the type of renewability provision
				contained in each policy form; such as guaranteed renewable;
(6) the type of coverage provided by each
				policy form; such as medical expense;
(7) identification of the type of rating
				methodology; such as issue age, attained age, or community rate;
(8) the National Association of Insurance
				Commissioners minimum guideline loss ratio and, if different, the insurer's
				minimum guideline loss ratio;
(9)
				the average annual premium for North Carolina and countrywide before and after
				the implementation date;
(10) the
				number of North Carolina and countrywide policyholders affected by the rate
				revision;
(11) the requested rate
				revision percentage attributable to experience;
(12) the requested rate revision percentage
				attributable to changes in benefits promulgated by Medicare, if applicable, and
				the calculation used to develop this percentage;
(13) identification and actuarial
				justification of all groupings of policy forms;
(14) the historical calendar year earned
				premium divided by duration and expressed on an actual and a current premium
				rate basis for the period of time from the earliest date that experience is
				recorded to the most recent date that experience is recorded;
(15) the "expected" incurred loss ratios by
				duration based upon original pricing assumptions for all policy durations
				considered in the original pricing;
(16) the "expected" lapse rates by duration
				based upon original pricing assumptions for all policy durations considered in
				the original pricing, including assumptions for voluntary lapse rates and
				mortality rates;
(17) the "actual"
				lapse rates for duration one through the duration coinciding with the calendar
				year for which the most recent experience is recorded;
(18) the historical calendar year incurred
				claims, for other than Medicare supplement insurance, covering the period of
				time from the earliest date that experience is recorded to the most recent date
				that experience is recorded;
(19)
				the historical calendar year incurred claims, for Medicare supplement
				insurance, expressed on an actual and a current benefit level basis covering
				the period of time from the earliest date experience is recorded to the most
				recent date that experience is recorded;
(20) a count of the number of incurred claims
				for each calendar year of data provided. The count shall be calculated by
				adding the total number of claims reported during the calendar year, whether
				paid or in the process of payment, plus the number of incurred but not reported
				claims at the end of the calendar year, minus the number of incurred but not
				reported claims at the beginning of the calendar year. For disability income
				insurance, only the initial claim payment for each period of disablement shall
				be counted. For each type of medical expense benefit, only the initial claim
				payment per cause shall be counted; for example, payments for continuation of a
				claim, such as refills on a prescription drug, shall be excluded from the
				incurred claim count;
(21) an
				estimation of the amount of policy year exposure contributed by all
				policyholders within each calendar year of data provided;
(22) a statement declaring whether this is an
				open block of business or a closed block of business;
(23) an estimation of the annual earned
				premium on new issues stated at the current premium rate basis for the period
				of time from the date that the most recent experience is last recorded to a
				date not exceeding the fifth year following the implementation date;
(24) the number of months that the rate will
				be guaranteed to an individual policyholder;
(25) the rate revision implementation method,
				such as the next premium due date following a given date, the next policy
				anniversary date, or otherwise. If otherwise, an explanation shall be
				included;
(26) a statement
				declaring the month and year of the earliest anticipated date of the next rate
				revision;
(27) an explanation and
				actuarial justification of the apportionment of the aggregate rate revision
				within each policy form or between policy forms that have been grouped and a
				demonstration that the apportionment of the aggregate rate revision yields the
				same premium income as if the rate revision had been applied
				uniformly;
(28) an explanation and
				actuarial justification, if applicable, for changing any factor that affects
				the premium;
(29) an explanation of
				the effect that the rate revision will have on the incurred loss ratio on those
				policies in force for three years or more as exhibited in the Medicare
				Supplement Experience Exhibit of the Annual Statement; and
(30) the name, address, and telephone number
				of an insurance company representative who will be available to answer
				questions relating to the rate revision.