For purposes of this subchapter, the following terms have the
meanings indicated, except where the context clearly indicates otherwise:
(1) Actuarial value (AV)--As defined in 45 CFR §156.20,
concerning Definitions.
(2) Cost-sharing reductions (CSRs)--As defined in 45
CFR §155.20, concerning Definitions.
(3) Essential health benefits (EHBs)--Health benefits
contained in the applicable "essential health benefits package" as
that term is defined in 45 CFR §156.20.
(4) Federal medical loss ratio standard--The applicable
medical loss ratio standard for the market segment involved, determined
under subpart B of 45 CFR part 158, concerning Issuer Use of Premium
Revenue: Reporting and Rebate Requirements.
(5) HHS--The U.S. Department of Health and Human Services.
(6) Issuer--An insurance company or health maintenance
organization that issues a plan that is subject to Insurance Code
Chapter 1698, concerning Rates for Certain Coverage.
(7) Index rate--A rate based on the total combined
claims costs for providing essential health benefits within the single
risk pool of the applicable market.
(8) Plan--As defined in 45 CFR §144.103, concerning
Definitions.
(9) Product--As defined in 45 CFR §154.102, concerning
Definitions.
(10) Qualified actuary--An actuary who is certified
by the American Academy of Actuaries to meet the U.S. Qualification
Standards.
(11) Single risk pool--With respect to a particular
issuer and for the purposes of considering claims experience and developing
an index rate, the grouping of all members enrolled in individual
market plans or small group market plans that are subject to this
chapter, consistent with 45 CFR §156.80, concerning Single Risk
Pool.
(12) Unified Rate Review Template (URRT)--A spreadsheet
that comprises Part I of the rate filing justification, as described
in 45 CFR §154.215, concerning Submission of Rate Filing Justification.
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