Spreadsheet: e5533742-5f43-481e-8b32-68ceab193052
Sheet: N1.  Summary for NHID

Exhibit N1:  Rate Filing Summary for NHID
Section 1:  Rate Filing Information
[NAME]:
[NAME]):
Market Segment:
Rate Effective Date:
1.  [NAME] for the Insurer and the person responsible for the filing:
2a.  Have there been changes to the rating methodology since the most recently approved rate filing? (Y/N)
2b.  If the answer above is "Y", then please provide a brief description of those changes:
3a.  Have there been changes to the benefits since the most recently approved rate filing? (Y/N)
3b.  If the answer above is "Y", then please provide a brief description of those changes.  Please identify benefit chages that are mandated (federal or state) versus benefit changes that are not mandated.
4.  Have there been changes to the rating factors since the most recently approved rating filing? (Yes/No)
5.  Components of the Average Proposed Rate Change:
a.  Utilization
[NAME]Unit Cost
[NAME] by Law
d.  Benefit Changes Not Required by Law
e.  Changes to Retention
f.  Over/Understatement of Prior Rates
g.  Other
6a.  Average Annual Proposed Rate Change including benefit changes:
6b.  Average Annual Rate Change from most recently approved rate filing including benefit changes:
6c.  Average Annual Proposed Rate Change excluding any benefit changes:
6d.  Average Annual Rate Change from most recently approved rate filing excluding any benefit changes:
7a.  Number of NH members affected by this Proposed Rate Change:
7b.  Number of NH subscribers affected by this Proposed Rate Change:
7c.  Number of NH groups affected by this Proposed Rate Change:
8a.  Annualized Trend Assumption from this filing:
8b.  Annualized Trend Assumption from most recently approved rate filing:
9a.  Annual NH Premium before Rate Request:1
9b.  Annual NH Premium after Rate Request:2
10a.  Historical Loss Ratio for Most Recent 12 Month Period:
10b.  [NAME] for the first projection period:3
11a.  Risk Based Capital- Legal Entity from most recent time period
11b.  Risk Based Capital- Corporate Entity from most recent time period
Notes:
1.  The annual NH premium before the rate change is calculated by taking the average base rate PMPM from the 12 months prior times the number of impacted members times 12.
2.  The annual NH premium after the rate change is calculated by taking the average proposed base rate PMPM in Exhibit A1, which includes the rate change from this filing, times the number of impacted members times 12.
3.  For the Individual Market, the first projection period will be the first full calendar year after the rate effective date and for the Small Group Market, the first projection period will be the twelve months immediately following the rate effective date.
Section 2:  Rate Review Criteria
ANSWERS OF "Y" TO ANY OF THESE QUESTIONS SUGGESTS NEED FOR FURTHER REVIEW
1.  [NAME]:  Does the annual proposed rate change for a plan type with more than 5% of the impacted membership vary by more than 5% from the average annual proposed rate change?
2.  [NAME]:  Does the average annual proposed rate change vary by more than 5 percentage points from the market average?4 | TBD
3.  [NAME]:  Is the average proposed annual rate change greater than or equal to 10%?
4.  Exhibit A5:  Does the over/understatment of prior rates contribute more than 50% of the total proposed annual rate change?
5.  Exhibit B1: Does the benefit level rate adjustment changes by more than 5 percentage points for any plan type with more than 5% of the impacted membership?
6. [NAME] and Exhibit A1: Does the final trend assumption vary by more than 2 percentage points from the average annual proposed rate change?
7. [NAME] the final trend assumptions vary by more than 1 percentage point from the market average?4 | TBD
8. [NAME] the final trend assumptions vary by more than 1 percentage point from the most recently approved filing?
9. Exhibit E3:  Is the proposed retention charge more than 5% greater than the retention charge from the prior 12 months filing?
10. Exhibit E3:  Is the contribution to surplus/profit more than 2% of the average base rate in this rate filing?
11. Exhibit E3:  Does the proposed retention charge vary by more than 2 percentage points from the market average?4 | TBD
12. Exhibit E3 and Exhibit L1: Is the investment income credit as a percent of the average annual propose rate different by more than 1 percentage point from the investment income on the financials as a percent of earned premium?
13. [NAME]:  Do the rates shown vary by more than 10% of the market average?4 | TBD
14. Exhibit M1 or M2: Does the loss ratio of the first projection period vary from the loss ratio of the most recent twelve months by more than 3 percentage points?4
15. [NAME], C1 & D3: Does the loss ratio of the latest two historical calendar year periods decrease by more than 2 percentage points and is the proposed rate change greater than the annual trend assumption?
16. [NAME], C1 & D3: Does the loss ratio of the latest two historical calendar year periods increase by more than 2 percentage points and is the proposed rate change less than the annual trend assumption?
17.   Exhibit M1 or M2: For the Individual Market, is the lifetime loss ratio in Exhibit M1 is less than 70%?  For the Small Group Market, is the projected loss ratio in the twelve months immediately following the rate effective date is less than 80%?
Notes:
3.  For the Individual Market, the first projection period will be the first full calendar year after the rate effective date and for the Small Group Market, the first projection period will be the twelve months immediately following the rate effective date.
4.  The NHID will define market average for each applicable criteria after a couple rating cycles.
Section 3:  Rate Filing Exhibits
Please indicate that each of the following exhibits are provided and complete:
[NAME] (Non-Standardized Exhibit)
Exhibit D1:  Description of Trend Assumptions (Non-Standardized Exhibit)
[NAME]Supporting Schedules for Trend Development (Non-Standardized Exhibit)
Exhibit G1: Individual Market Example 1 (Non-Standardized Exhibit)
Exhibit G2:  Individual Market Example 2 (Non-Standardized Exhibit)
Exhibit G3:  Small Group Market Example 1 (Non-Standardized Exhibit)
Exhibit G4:  Small Group Market Example 2 (Non-Standardized Exhibit)
Exhibit G5: Illustrative Rates
Exhibit H2:  Rating Factors (Non-Standardized Exhibit)
Exhibit J1:  Base Rate PMPM Development for Standard Plan Type
Exhibit M3:  Description of Methodology for Projected Loss Ratio (Non-Standardized Exhibit)