(1)(a) For
calendar years prior to January 1, 2010, rates and rate schedules
may be adjusted for appropriate risk factors such as age, sex, and area variation
in claim costs in accordance with established actuarial and underwriting practices.
Special rates shall be provided for children under eighteen years of age.
(b)For calendar years prior to January
1, 2010, the pool, with the assistance of an independent actuary,
shall determine the standard risk rate by calculating the average individual
rate charged by the five insurers writing the largest amount of individual
health insurance coverage in the state actuarially adjusted to be comparable
with the pool coverage, except that such five insurers shall not include any
insurer which has not been writing individual health insurance coverage
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(1)(a) For
calendar years prior to January 1, 2010, rates and rate schedules
may be adjusted for appropriate risk factors such as age, sex, and area variation
in claim costs in accordance with established actuarial and underwriting practices.
Special rates shall be provided for children under eighteen years of age.
(b) For calendar years prior to January
1, 2010, the pool, with the assistance of an independent actuary,
shall determine the standard risk rate by calculating the average individual
rate charged by the five insurers writing the largest amount of individual
health insurance coverage in the state actuarially adjusted to be comparable
with the pool coverage, except that such five insurers shall not include any
insurer which has not been writing individual health insurance coverage in
this state in at least the three preceding calendar years. The selection of
the independent actuary shall be subject to the approval of the director.
In the event five insurers do not offer comparable coverage, the standard
risk rate shall be established using reasonable actuarial techniques and shall
reflect anticipated risk experience and expenses for such coverage. The annual
premium rate established for pool coverage shall be one hundred thirty-five
percent of rates established as applicable for individual standard risks,
except that the annual premium rate established for pool coverage for children
under eighteen years of age shall be sixty-seven and five-tenths percent of
rates established as applicable for individual standard risks.
(2)(a) For calendar years beginning on
and after January 1, 2010, rates and rate schedules may be adjusted for appropriate
risk factors such as age, sex, and area variation in claim costs in accordance
with established actuarial and underwriting practices.
(b)(i) For calendar years beginning on
and after January 1, 2010, the pool, with the assistance of an independent
actuary, shall determine the standard risk rate by calculating the average
individual rate charged by the ten insurers writing the largest amount of
individual health insurance coverage in the state actuarially adjusted to
be comparable with the pool coverage, except that such ten insurers shall
not include any insurer which has not been writing individual health insurance
coverage in this state in at least the three preceding calendar years. The
selection of the independent actuary shall be subject to the approval of the
director. In the event ten insurers do not offer comparable coverage, the
standard risk rate shall be established using reasonable actuarial techniques
and shall reflect anticipated risk experience and expenses for such coverage.
(ii)(A) The annual premium rate established
for pool coverage for calendar year 2010 (I) shall be one hundred forty percent
of rates established as applicable for individual standard risks or (II) shall
be the rates established as applicable for individual standard risks for the
previous calendar year adjusted by a trend factor reflecting medical economic
factors as the board deems appropriate, whichever is greater.
(B) The annual premium rate established
for pool coverage for calendar year 2011 (I) shall be one hundred forty-five
percent of rates established as applicable for individual standard risks or
(II) shall be the rates established as applicable for individual standard
risks for the previous calendar year adjusted by a trend factor reflecting
medical economic factors as the board deems appropriate, whichever is greater.
(C) The annual premium rate established
for pool coverage for calendar year 2012 and each calendar year thereafter
(I) shall be one hundred fifty percent of rates established as applicable
for individual standard risks or (II) shall be the rates established as applicable
for individual standard risks for the previous calendar year adjusted by a
trend factor reflecting medical economic factors as the board deems appropriate,
whichever is greater.
(3) The board shall not adjust
or increase pool rates more than one time during any calendar year. All rates
and rate schedules shall be submitted to the director for approval. The director
shall hold a public hearing pursuant to the Administrative Procedure Act prior
to approving an adjustment to or increase in pool rates.