Sec. 25. Premium Rates.

723 words·~3 min read·/il/chapter-215/act-93/25

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)Premium rates for health benefit plans subject to this Act shall be subject to all of the following provisions:

(1)The index rate for a rating period for any class of business shall not exceed the

index rate for any other class of business by more than 20%.

(2)For a class of business, the premium rates charged during a rating period to small

employers with similar case characteristics for the same or similar coverage, or the rates that could be charged to such employers under the rating system for that class of business, shall not vary from the index rate by more than 25% of the index rate.

(3)The percentage increase in the premium rate charged to a small employer for a new

rating period shall not exceed the sum of the following:

(A)the percentage change in the new business premium rate measured from the first

day of the prior rating period to the first day of the new rating period. In the case of a health benefit plan into which the small employer carrier is no longer enrolling new small employers, the small employer carrier shall use the percentage change in the base premium rate;

(B)an adjustment, not to exceed 15% annually and adjusted pro rata for rating

periods of less than one year, due to claim experience, health status, or duration of coverage of the employees or dependents of the small employer as determined from the small employer carrier's rate manual for the class of business; and

(C)any adjustment due to change in coverage or change in the case characteristics

of the small employer as determined from the small employer carrier's rate manual for the class of business.

(4)Adjustments in rates for a new rating period due to claim experience, health status,

and duration of coverage shall not be charged to individual employees or dependents. Any such adjustment shall be applied uniformly to the rates charged for all employees and dependents of the small employer.

(5)In the case of health benefit plans delivered or issued for delivery prior to the

effective date of this Act, a premium rate for a rating period may exceed the ranges set forth in items

(1)and

(2)of this subsection

(a)for a period of 3 years following the effective date of this Act. In such case, the percentage increase in the premium rate charged to a small employer for a new rating period shall not exceed the sum of the following:

(A)the percentage change in the new business premium rate measured from the first

day of the prior rating period to the first day of the new rating period; in the case of a class of business into which the small employer carrier is no longer enrolling new small employers, the small employer carrier shall use the percentage change in the base premium rate, provided that such change does not exceed, on a percentage basis, the change in the new business premium rate for the most similar class of business into which the small employer carrier is actively enrolling new small employers; and

(B)any adjustment due to change in coverage or change in the case characteristics

of the small employer as determined from the carrier's rate manual for the class of business.

(6)Small employer carriers shall apply rating factors, including case characteristics,

consistently with respect to all small employers in a class of business. A small employer carrier shall treat all health benefit plans issued or renewed in the same calendar month as having the same rating period.

(7)For the purposes of this subsection, a health benefit plan that contains a

restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restriction of benefits to network providers results in substantial differences in claim costs.

(b)A small employer carrier shall not transfer a small employer involuntarily into or out of a class of business. A small employer carrier shall not offer to transfer a small employer into or out of a class of business unless such offer is made to transfer all small employers in the class of business without regard to case characteristics, claim experience, health status, or duration of coverage since issue.