83-63-9 - Disclosure requirements for solicitation and sales material for sale of health benefit plan; maintenance of description of rating practices and renewal underwriting practices; actuarial cert
§ 83-63-9. Disclosure requirements for solicitation and sales material for sale of health benefit plan; maintenance of description of rating practices and renewal underwriting practices; actuarial certification requirements; access to information and documentation by commissioner; confidentiality of information.
(1) In connection with the offering for sale of any health benefit plan to a small employer, a small employer carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following:
(a) The extent to which premium rates for a specified small employer are established or adjusted based upon the actual or expected variation in claims costs or actual or expected variation in health status of the employees of the small employer and their dependents;
(b) The provisions of the health benefit plan concerning the small employer carrier's right to change premium rates and factors, other than claim experience, that affect changes in premium rates;
(c) A description of the class of business in which the small employer is or will be included, including the applicable grouping of plans;
(d) The provisions relating to renewability of policies and contracts; and
(e) The provisions relating to any pre-existing condition provision.
(2) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
(3) Each small employer carrier shall file with the commissioner annually on or before March 15, an actuarial certification certifying that the carrier is in compliance with this chapter and that the rating methods of the small employer carrier are actuarially sound. Such certification shall be in a form and manner, and shall contain such information, as specified by the commissioner. A copy of the certification shall be retained by the small employer carrier at its principal place of business.
(4) A small employer carrier shall make the information and documentation described in subsection (2) available to the commissioner upon request. Except in cases of violations of this chapter, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the commissioner to persons outside of the department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.
Sources: Laws, 1994, ch. 302, § 5, eff from and after January 1, 1995.