Terms Used In Louisiana Revised Statutes > Title 22 > Chapter 4 > Part III > Subpart D - Rate Review

• Actuarial certification: means a written statement by a member of the American Academy of Actuaries that a health insurance issuer is in compliance with the provisions of this Subpart, based upon the actuary's examination, including a review of the appropriate records and of the actuarial assumptions and methods utilized by the health insurance issuer in establishing rates for applicable health benefit plans. See Louisiana Revised Statutes 22:1091
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
• Arraignment: A proceeding in which an individual who is accused of committing a crime is brought into court, told of the charges, and asked to plead guilty or not guilty.
• Arrest: Taking physical custody of a person by lawful authority.
• Bail: Security given for the release of a criminal defendant or witness from legal custody (usually in the form of money) to secure his/her appearance on the day and time appointed.
• Contract: A legal written agreement that becomes binding when signed.
• Conviction: A judgement of guilt against a criminal defendant.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Dependent: A person dependent for support upon another.
• Dismissal: The dropping of a case by the judge without further consideration or hearing. ^Source:
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• 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 coverage: means services consisting of medical care, provided directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization, or health maintenance organization contract offered by a health insurance issuer. 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
• Inadequate: means rates for a particular product are clearly insufficient to sustain projected losses and expenses, or the use of such rates. See Louisiana Revised Statutes 22:1091
• Index rate: means the average rate resulting from the estimated combined claims experience for all Essential Health Benefits, pursuant to 42 U. 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
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• large employer: means , in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one employees on business days during the preceding calendar year and who employs at least two employees on the first day of the plan year. 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
• Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
• Particular product: means a basic insurance policy form, certificate, or subscriber agreement delineating the terms, provisions, and conditions of a specific type of coverage or benefit under a particular type of contract with a discrete set of rating and pricing methodologies that a health insurance issuer offers in the state. See Louisiana Revised Statutes 22:1091
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
• Quorum: The number of legislators that must be present to do business.
• 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
• small employer: means any person, firm, corporation, partnership, trust, or association actively engaged in business which has employed an average of at least one but not more than fifty employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. See Louisiana Revised Statutes 22:1091
• Trustee: A person or institution holding and administering property in trust.
• 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