§ 10181.6
247 words·~1 min read·
/ca/insurance-code/10181-6A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)A filing submitted under this article shall be actuarially sound.
(1)The health insurer shall contract with an independent actuary or actuaries consistent with this section.
(2)A filing submitted under this article shall include a certification by an independent actuary or actuarial firm that the rate increase is reasonable or unreasonable and, if unreasonable, that the justification for the increase is based on accurate and sound actuarial assumptions and methodologies. Unless PPACA requires a certification of actuarial soundness for each large group health insurance policy, a filing submitted under Section 10181.4 shall include a certification by an independent actuary, as described in this section, that the aggregate or average rate increase is based on accurate and sound actuarial assumptions and methodologies.
(3)The actuary or actuarial firm acting under paragraph
(2)shall not be an affiliate or a subsidiary of, nor in any way owned or controlled by, a health insurer or a trade association of health insurers. A board member, director, officer, or employee of the actuary or actuarial firm shall not serve as a board member, director, or employee of a health insurer. A board member, director, or officer of a health insurer or a trade association of health insurers shall not serve as a board member, director, officer, or employee of the actuary or actuarial firm.
(c)Nothing in this article shall be construed to permit the commissioner to establish the rates charged insureds and policyholders for covered health care services.