RSA 420-G:4 · Premium Rates

420-G:4 Premium Rates. –

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I.

Health carriers providing health coverage to individuals and small employers under this chapter shall be subject to the following:

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(a)

All premium rates charged shall be guaranteed for a rating period of at least 12 months, and shall not be changed for any reason, including but not limited to a change in the group's case characteristics.

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(b)

Market rate shall be established by each health carrier for all of its health coverages offered to individuals and, separately, for all of its health coverages offered to small employers.

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(c)

Health carriers shall calculate health coverage plan rates for each of the coverages or health benefit plans written by that carrier. Variations in health coverage plan rates shall be solely attributable to variations in expected utilization or cost due to differences in coverage design and/or the provider contracts or other provider costs associated with specific coverages and shall not reflect differences due to the nature of the groups or eligible persons assumed to select particular health coverages. (d)(1) In establishing the premium charged, health carriers providing coverage to individuals and small employers shall vary the premium rate with respect to the particular plan or coverage involved only by:

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(A)

Whether the plan or coverage covers an individual or family;

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(B)

Geographic rating area, except that the state shall constitute a single geographic rating area;

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(C)

Age, except that the maximum premium differential for age as determined by ratio shall be 3 to 1 for adults; and

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(D)

Tobacco use, except that the maximum differential rate due to tobacco use shall be 1.5 to 1.

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(2)

With respect to family coverage under an individual or small group health insurance policy, the rating variations permitted under subparagraphs (1)(A) and (D) shall be applied based on the portion of the premium that is attributable to each family member covered under the plan.

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(3)

Carriers shall adjust each health coverage plan or premium rate for age, based on the portion of the premium that is attributable to each family member covered under the plan or certificate, using the uniform age rating factors established by the commissioner pursuant to RSA 420-G:14, I(a)(2).

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(e)

[Repealed.]

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(f)

Each rating factor that a carrier chooses to utilize in the individual market shall be reflective of claim cost variations that correlate with that factor independently of claim cost variations that correlate with any of the other allowable factors.

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(g)

The same rating methodology shall apply to newly covered individuals and to individuals renewing at each annual renewal date, or to new small employers and small employers renewing at each annual renewal date or anniversary date. Rating methodology shall not be construed to include health carrier incentives to individual subscribers or members to participate in wellness and fitness programs provided such incentives are approved by the insurance department.

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(h)

The commissioner shall not approve any filing if such filing is excessive, inadequate, or contrary to the intent of this chapter.

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II.

(a) Health carriers providing health coverage to large employers may not require any person, as a condition of receiving health coverage or continued health coverage, to pay a premium or contribution that is greater than that of similarly situated persons based on any health status related factor of that person or that person's dependents.

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(b)

Nothing in subparagraph (a) shall be construed to restrict the amount that a health carrier may charge a large employer, nor to prevent a health carrier from establishing premium discounts or rebates or modifying copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

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III.

[Repealed.] Source. 1997, 344:1. 1998, 340:9, 10. 2001, 295:2; 296:1, 2. 2003, 188:5, 6, 15. 2005, 225:9, 10, 13, 15. 2013, 272:5, 6, eff. Jan. 1, 2014. 2019, 220:3, eff. Sept. 10, 2019.

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