§ 58-51-95. Approval by Commissioner of forms, classification and rates; hearing; exceptions.
§ 58‑51‑95. Approval by Commissioner of forms, classification and rates; hearing;exceptions.
(a) No policy ofinsurance against loss or expense from the sickness, or from the bodily injuryor death by accident of the insured shall be issued or delivered to any personin this State nor shall any application, rider or endorsement be used inconnection therewith until a copy of the form thereof and of the classificationof risks and the premium rates, or, in the case of cooperatives or assessmentcompanies the estimated cost pertaining thereto, have been filed with theCommissioner.
(b) No such policyshall be issued, nor shall any application, rider or endorsement be used inconnection therewith, until the expiration of 90 days after it has been sofiled unless the Commissioner shall sooner give his written approval thereto.
(c) The Commissionermay within 90 days after the filing of any such form, disapprove such form
(1) If the benefitsprovided therein are unreasonable in relation to the premium charged, or
(2) If it contains aprovision or provisions which are unjust, unfair, inequitable, misleading,deceptive or encourage misrepresentation of such policy.
(d) If the Commissionershall notify the insurer which has filed any such form that it does not complywith the provisions of this section or sections, it shall be unlawfulthereafter for such insurer to issue such form or use it in connection with anypolicy. In such notice the Commissioner shall specify the reasons for hisdisapproval and state that a hearing will be granted within 20 days afterrequest in writing by the insurer.
(e) The Commissionermay at any time, after a hearing of which not less than 20 days' written noticeshall have been given to the insurer, withdraw his approval of any such form onany of the grounds stated in this section. It shall be unlawful for the insurerto issue such form or use it in connection with any policy after the effectivedate of such withdrawal of approval. The notice of any hearing called underthis paragraph shall specify the matters to be considered at such hearing andany decision affirming disapproval or directing withdrawal of approval underthis section shall be in writing and shall specify the reasons therefor:Provided, that the provisions of this section shall not apply to workers'compensation insurance, accidental death or disability benefits issuedsupplementary to life insurance or annuity contracts, medical expense benefitsunder liability policies or to group accident and health insurance.
(f) An insurer mayrevise rates chargeable on policies subject to this section, other thannoncancellable policies, with the approval of the Commissioner if theCommissioner finds that the revised rates are not excessive, not inadequate,and not unfairly discriminatory; and exhibit a reasonable relationship to thebenefits provided by the policies. The approved rates shall be guaranteed bythe insurer, as to the policyholders affected by the rates, for a period of notless than 12 months; or as an alternative to the insurer giving the guarantee,the approved rates may be applicable to all policyholders at one time if theinsurer chooses to apply for that relief with respect to those policies no morefrequently than once in any 12‑month period. The rates shall be applicableto all policies of the same type; provided that no rate revision may becomeeffective for any policy unless the insurer has given the policyholder writtennotice of the rate revision 45 days before the effective date of the revision.The policyholder must then pay the revised rate in order to continue the policyin force. The Commissioner may adopt reasonable rules, after notice andhearing, to require the submission of supporting data and such information asthe Commissioner considers necessary to determine whether the rate revisionsmeet these standards. In adopting the rules under this subsection, theCommissioner may require identification of the types of rating methodologiesused by filers and may also address issue age or attained age rating, or both;policy reserves used in rating; and other recognized actuarial principles ofthe NAIC, the American Academy of Actuaries, and the Society of Actuaries.
(g) For policiessubject to this section, an individual health insurer shall not increase anindividual's renewal premium for continued health insurance coverage under theterms of the individual's health insurance policy based on any health status‑relatedfactors in relation to the individual or a dependent of the individual,including:
(1) Health status.
(2) Medical condition(including physical and mental illnesses).
(3) Claims experience.
(4) Duration from issue.
(5) Receipt of healthcare.
(6) Medical history.
(7) Genetic information.
(h) Every policy thatis subject to this section and that provides individual accident and healthinsurance benefits to a resident of this State shall return to policyholdersbenefits that are reasonable in relation to the premium charged. TheCommissioner may adopt rules or utilize existing rules to establish minimumstandards for loss ratios of policies on the basis of incurred claimsexperience and earned premiums in accordance with accepted actuarial principlesand practices to assure that the benefits are reasonable in relation to thepremium charged. Every insurer providing policies in this State subject to thissection shall not less than annually file for approval its rates, ratingschedules, and supporting documentation to demonstrate compliance with theapplicable loss ratio standards of this State as adopted by the Commissioner.All filings of rates and rating schedules shall comply with the standardsadopted by the Commissioner. The filing shall include a certification by anindividual who is either a Fellow or an Associate of the Society of Actuariesor a Member of the American Academy of Actuaries that the rates are notexcessive, not inadequate, and not unfairly discriminatory; and that the ratesexhibit a reasonable relationship to the benefits provided by the policy.Nothing in this subsection shall require an insurer to provide certificationwith respect to a previous rate period, or to require an insurer to reduceproperly filed and approved rates before the end of a rate period. Thissubsection does not apply to any long‑term care policy issued in this Stateon or after February 1, 2003, and noncancellable accident and health insurance.
(i) For any long‑termcare policy issued in this State on or after February 1, 2003, an insurer shallon or before March 15 of each year:
(1) Provide to theCommissioner an actuarial certification listing all of its long‑term carepolicy forms available for sale in this State as of December 31 of the prioryear, stating that the current premium rate schedule for each form issufficient to cover anticipated costs under moderately adverse experience andstating that the premium rate schedule is reasonably expected to be sustainableover the life of the form with no future premium increases anticipated.
(2) For any policy formfor which the statement in subdivision (1) of this subsection cannot be made oris qualified, submit a plan of corrective action to the Commissioner forapproval.
(j) For purposes ofthis section, accident and health insurance means insurance against death orinjury resulting from accident or from accidental means and insurance againstdisablement, disease, or sickness of the insured. This includes Medicaresupplemental insurance, long‑term care, nursing home, or home health careinsurance, or any combination thereof, specified disease or illness insurance,hospital indemnity or other fixed indemnity insurance, short‑term limitedduration health insurance, dental insurance, vision insurance, and medical,hospital, or surgical expense insurance or any combination thereof.Notwithstanding any other provision to the contrary, subsection (h) of thissection does not apply to disability income insurance. (1951, c. 784; 1979, c. 755,s. 15; 1989, c. 485, s. 56; 1991, c. 636, s. 3; c. 720, s. 4; 2001‑334,s. 17.3; 2005‑223, s. 1(b); 2005‑412, ss. 1(a), 1(b).)