Louisiana Revised Statutes 22:1092 – A. Every health insurance issuer shall file with the department every proposed rate to be used in connection with all of its particular products. Every such filing shall clearly stat
Terms Used In Louisiana Revised Statutes 22:1092
- Excessive: means the rate charged for the health insurance coverage causes the premium or premiums charged for the health insurance coverage to be unreasonably high in relation to the benefits provided under the particular product. See Louisiana Revised Statutes 22:1091
- Federal review threshold: means any rate increase that results in a ten percent or greater rate increase, or such other threshold as required by federal law or regulation or any rate that, when combined with all rate increases and decreases during the previous twelve-month period, would result in an aggregate ten percent or greater rate increase. See Louisiana Revised Statutes 22:1091
- Health insurance issuer: means any entity that offers health insurance coverage through a policy, certificate of insurance, or subscriber agreement subject to state law that regulates the business of insurance. See Louisiana Revised Statutes 22:1091
- Individual market: means the market for health insurance coverage offered to individuals other than in connection with a group health plan. See Louisiana Revised Statutes 22:1091
- Insured: includes any policyholder, including a dependent, enrollee, subscriber, or member, who is covered through any policy or subscriber agreement offered by a health insurance issuer. See Louisiana Revised Statutes 22:1091
- Medical loss ratio: means the ratio of expected incurred benefits to expected earned premium over the time period of coverage, subject to the requirements of federal law, regulation, or rule. See Louisiana Revised Statutes 22:1091
- Rate: means the rate initially filed or filed as a result of determination of rates by a health insurance issuer for a particular product. See Louisiana Revised Statutes 22:1091
- rate increase: includes a premium volume-weighted average increase for all insureds for the aggregate rate changes during the twelve-month period preceding the proposed rate increase effective date. See Louisiana Revised Statutes 22:1091
- Unfairly discriminatory: means rates that result in premium differences between insureds within similar risk categories that do not reasonably correspond to differences in expected costs. See Louisiana Revised Statutes 22:1091
- Unjustified: means a rate for which a health insurance issuer has provided data or documentation to the department in connection with rates for a particular product that is incomplete, inadequate, or otherwise does not provide a basis upon which the reasonableness of the rate may be determined or is otherwise inadequate insofar as the rate charged is clearly insufficient to sustain projected losses and expenses. See Louisiana Revised Statutes 22:1091
- Unreasonable: means any rate that contains a provision or provisions that are any of the following:
(a) Excessive. See Louisiana Revised Statutes 22:1091
A. Every health insurance issuer shall file with the department every proposed rate to be used in connection with all of its particular products. Every such filing shall clearly state the date of the filing, the proposed rate, and the effective date of the proposed rate. All rate filings required by this Subpart shall be made in accordance with the following:
(1) Rate filings shall be made within the time prescribed by the department.
(2) All health insurance issuers assuming, merging, or acquiring blocks of business shall be considered as proposing new rates.
(3) The commissioner may set the date upon which index rates in a market are not subject to revision by an issuer.
B. All proposed rate filings shall be filed in the manner and form prescribed by the department.
C. When a rate filing made pursuant to this Subpart is not accompanied by the information upon which the health insurance issuer supports the rate filing, with the result that the department does not have sufficient information to determine whether the rate filing meets the requirements of this Subpart, the department may require the health insurance issuer to refile the information upon which it supports its filing. The time period provided in this Section shall begin anew and commence as of the date the proper information is furnished to the department.
D. All proposed rate filings may be reviewed for compliance with La. Rev. Stat. 22:1095 and with other provisions of law governing rates in the individual market and the small group market. A review of rates made pursuant to this Subpart shall not constitute a determination under the Administrative Procedure Act, La. Rev. Stat. 49:950 et seq., nor shall such a review of rates be subject to other administrative or judicial relief.
E. Each rate filing shall be reviewed by the department to determine whether such filing is reasonable and compliant with this Subpart.
F. The department shall consider the following criteria to determine whether a rate is unreasonable:
(1) Whether the rate is excessive.
(2) Whether the rate is unfairly discriminatory.
(3) Whether the rate is unjustified.
(4) Whether the rate does not otherwise comply with the provisions of this Title or with other provisions of law.
G. The review of any proposed rate may take into consideration the following nonexhaustive list of factors and any other factors established by federal rule or regulation to the extent applicable, to determine whether the filing under review is unreasonable:
(1) The impact of medical trend changes by major service categories.
(2) The impact of utilization changes by major service categories.
(3) The impact of cost-sharing changes by major service categories.
(4) The impact of benefit changes.
(5) The impact of changes in an insured‘s risk profile.
(6) The impact of any overestimate or underestimate of medical trend for prior year periods related to the rate increase, if applicable.
(7) The impact of changes in reserve needs.
(8) The impact of changes in administrative costs related to programs that improve healthcare quality.
(9) The impact of changes in other administrative costs.
(10) The impact of changes in applicable taxes or licensing or regulatory fees.
(11) Medical loss ratio.
(12) The financial performance of the health insurance issuer, including capital and surplus levels.
H. Within fifteen days of submission of any proposed rate increase that meets or exceeds the federal review threshold, the department shall publish on its website any documents or forms as required by federal law, rule, or regulation to maintain an effective rate review program. After publication, the public shall have thirty days to submit comments.
I. For any rate increase that meets or exceeds the federal review threshold, the department shall post a notice of final determination on its website and undertake any other actions necessary pursuant to federal law.
Acts 1991, No. 777, §2, eff. Sept. 30, 1992; Acts 2001, No. 272, §1, eff. Jan. 1, 2002; Redesignated from La. Rev. Stat. 22:228.2 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2014, No. 718, §1, eff. June 18, 2014; Acts 2020, No. 36, §1.