§ 27-13-20-1.5 — Required considerations for approval of rates

Indiana § 27-13-20-1.5

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 20: Filing Requirements

Text

5. (a) Before approving or disapproving an
increase or decrease in the rates to be used by a health maintenance
organization, the commissioner shall review the following:
(1) The products affected, by line of business.
(2) The number of covered lives affected.
(3) Whether the product is open or closed to new members in the
product block.
(4) Applicable median cost sharing for the product, as allowed by
state or federal law.
(5) The benefits provided and the underlying costs of the health
services rendered.
(6) The implementation date of the increase or decrease.
(7) The overall percent premium rate increase or decrease that is
requested.
(8) The actual percent premium rate increase or decrease to be
approved.
(9) Incurred claims paid each year for the past three (3) years, if
applicable.
(10) Earned premiums for each of the past three (3) years, if
applicable.
(11) Projected medical cost trends in the geographic service
region, if the product for which a rate increase or decrease is
requested is not a product offered statewide.
(12) If applicable, historical rebates paid to the enrollee from the
most recent health plan year under the federal Patient Protection
and Affordable Care Act (P.L. 111-148), as amended by the
federal Health Care and Education Reconciliation Act of 2010
(P.L. 111-152).
(13) The median cost sharing amount for a member enrolled in
the product, or the actuarial value information as required under
the Patient Protection and Affordable Care Act, if applicable.
(b) The commissioner shall not approve a rate increase or decrease
for an existing product unless the commissioner has, at a minimum,
considered the matters set forth in subsection (a)(1) through (a)(13).
(c) The information compiled, prepared, and considered by the
commissioner under subsection (a)(1) through (a)(13) is subject to the
requirements of IC 5-14-3. However, the commissioner's approval of
a rate increase or decrease may take effect before the information
compiled, prepared, and considered by the commissioner under
subsection (a)(1) through (a)(13) is made accessible to the public under
IC 5-14-3.
(d) When considering whether to approve a premium rate increase,
the commissioner shall consider whether the current rate is appropriate
for achieving the target loss ratio of the health maintenance
organization.
(e) To the extent authorized by the Patient Protection and
Affordable Care Act and other federal law, the commissioner, under
this section, may:
(1) consider network adequacy;
(2) conduct form review to ensure:
(A) minimum essential health benefits; and
(B) nondiscriminatory benefit design;
(3) perform accreditation confirmation; and
(4) confirm quality measures.

Legislative History

As added by P.L.190-2023, SEC.34.