RS 22:1095 Modified community rating; health insurance premiums; compliance with rules and regulations
§1095. Modified community rating; health insurance premiums; compliance with rules and regulations
A. Each small group and individual health and accident insurer shall maintain at its principal place of business a complete and detailed description of its rating practices and a renewal underwriting description of its rating practices and renewal underwriting practices, including information and documentation which demonstrate that its rating methods and practices are in full and complete compliance with the rules and regulations promulgated by the Department of Insurance for a modified community rating system for health insurance premiums.
B.(1) The Department of Insurance shall promulgate regulations no later than January 1, 1994, that provide criteria for the community rating of premiums for any hospital, health, or medical expense insurance policy, hospital or medical service contract, health and accident policy or plan, or any other insurance contract of this type, that is small group or individually written.
(2)(a) The regulations shall place limitations upon the following classification factors used by any insurer or group in the rating of individuals and their dependents for premiums:
(i) Medical underwriting and screening.
(ii) Experience and health history rating.
(iii) Tier rating.
(iv) Durational rating.
(b) The premiums charged shall not deviate according to the classification factors in Subparagraph (a) of this Paragraph by more than plus or minus thirty-three percent for individual health insurance policies or subscriber agreements. In no event shall the increase in premiums for a small employer group policy vary from the index rate by plus or minus thirty-three percent.
(3) The following classification factors may be used by any small group or individual insurance carrier in the rating of individuals and their dependents for premiums:
(a) Age.
(b) Gender.
(c) Industry.
(d) Geographic area.
(e) Family composition.
(f) Group size.
(g) Tobacco usage.
(h) Plan of benefits.
(i) Other factors approved by the Department of Insurance.
C. Any small group and individual insurance carrier that varies rates by health status, claims experience, duration, or any other factor in conflict with the regulations promulgated by the Department of Insurance shall establish a phase-out rate adjustment as of the first renewal date on or after January 1, 2002, for each entity insured by the carrier in order to come into compliance with this Section pursuant to the regulations promulgated by the Department of Insurance.
D. The provisions of this Section shall not apply to individually underwritten limited benefit and supplemental health insurance policies.
Acts 1993, No. 655, §1; Acts 1995, No. 593, §1; Acts 1995, No. 1173, §1; Acts 1997, No. 1165, §1; Acts 2001, No. 272, §1, eff. Jan. 1, 2002; Acts 2004, No. 426, §1; Redesignated from R.S. 22:228.6 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.