| (a) Premium rates to be charged for qualifying group health benefit plans must be filed with the department for review and approval by the commissioner in a form and within the timeframe set by the commissioner. (1) In accordance with the Insurance Code §1508.202(c), a health benefit plan issuer may use only age and gender as case characteristics, as defined in the Insurance Code §1501.201(2), in setting premium rates for a qualifying health benefit plan. (2) Pursuant to the Insurance Code §1508.202(d), a health benefit plan issuer may use the geographic location of the employer's place of business as an additional criterion in setting premium rates for a qualifying health benefit plan. (3) A health benefit plan issuer may not use a "health status related factor" as defined in the Insurance Code §1501.002(7) in setting premium rates for a qualifying health benefit plan. (b) Premium rates established for qualifying group health benefit plans must recognize and consider the availability of reimbursement from the fund. In considering fund reimbursement availability, a participating group health benefit plan issuer may rely on: (1) Available annual reported and published data concerning Healthy Texas Program enrollment and operations; and (2) Available data communicated by the commissioner on an ongoing basis. (c) Rating factors shall be applied consistently with respect to all small employers in a class of business. (d) Reimbursement from the fund shall reduce claims expenses for the purposes of calculating loss ratios, premium rates and premium rate adjustments. (e) Initial rate submissions and rate adjustment applications submitted for qualifying group health benefit plans shall contain such information as may be needed and prescribed by the commissioner in order to assist the commissioner in determining the anticipated premium rate impact on the availability of reimbursement from the fund. (f) Estimates of anticipated receipts from the fund may be calculated based upon available enrollment data and such other data as may be deemed appropriate by the commissioner. |
