58-17-74 Provisions for premium rates for individual health benefit plans.
Provisions for premium rates for individual health benefit plans.
for individual health benefit plans subject to §§ 58-17-66 to 58-17-87, inclusive, are subject to the
Any new policy issued after the effective date of §§ 58-17-66 to 58-17-87, inclusive, is
subject to the provisions of §§ 58-17-66 to 58-17-87, inclusive;
The index rate for a rating period for any class of individual business may not exceed the
index rate for any other class of individual business by more than twenty percent;
For a class of business, the premium rates charged during a rating period to individuals
with similar case characteristics for the same or similar coverage, or the rates that could
be charged to such individuals under the rating system for that class of business, may not
vary from the index rate by more than thirty percent of the index rate;
An adjustment applied to a single block of business may not exceed the adjustment
applied to all blocks of business by more than fifteen percent due to the claim experience
or health status of that block of business;
Any adjustment in rates for claim experience and duration of coverage may not be
charged to specific individual policyholders. Any such adjustment shall be applied
uniformly to the rates charged for any person and dependents of the person within each
class of business;
Premium rates for individual health benefit plans shall comply with the requirements of
§§ 58-17-66 to 58-17-87, inclusive;
Each carrier shall apply rating factors consistently with respect to all persons in a class of
business. Rating factors shall produce premiums for identical persons which differ only
by the amounts attributable to plan design;
No carrier may use characteristics other than age, gender, lifestyle, family composition,
and geographic area without prior approval of the director. The maximum rating
differential based solely on age may not exceed a factor of 5:1; and
All rate adjustments based on geographic area shall reflect actual differences in the health
care costs of the respective areas.
The rating provisions of subdivisions (1), (2), (3), (4), and (6) of this section do not apply to
individual health benefit plans issued by a carrier to qualifying individuals on a guaranteed issue
basis. However, the rate for any individual covered on a guaranteed issue basis may not exceed two
and one half times the base rate of the class of business with the lowest index rate.
Source: SL 1996, ch 286, § 9; SL 2008, ch 263, § 1.