Health insurance issuers must file proposed rates with the department, and the department reviews those filings and posts certain notices for large increases.
§1092. Health insurance issuers; rate filings and rate increases 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 R.S. 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, R.S. 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 R.S. 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.