Indiana § 27-13-20-1.5 - Required considerations for approval of rates

§ 27-13-20-1.5. Required considerations for approval of rates

Sec. 1.5. (a) Before approving or disapproving an increase or decrease in the rates to be used by a health maintenance organization, the commissioner shall review the following:

(1) The products affected, by line of business.

(2) The number of covered lives affected.

(3) Whether the product is open or closed to new members in the product block.

(4) Applicable median cost sharing for the product, as allowed by state or federal law.

(5) The benefits provided and the underlying costs of the health services rendered.

(6) The implementation date of the increase or decrease.

(7) The overall percent premium rate increase or decrease that is requested.

(8) The actual percent premium rate increase or decrease to be approved.

(9) Incurred claims paid each year for the past three (3) years, if applicable.

(10) Earned premiums for each of the past three (3) years, if applicable.

(11) Projected medical cost trends in the geographic service region, if the product for which a rate increase or decrease is requested is not a product offered statewide.

(12) If applicable, historical rebates paid to the enrollee from the most recent health plan year under the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152).

(13) The median cost sharing amount for a member enrolled in the product, or the actuarial value information as required under the Patient Protection and Affordable Care Act, if applicable.

(b) The commissioner shall not approve a rate increase or decrease for an existing product unless the commissioner has, at a minimum, considered the matters set forth in subsection (a)(1) through (a)(13).

(c) The information compiled, prepared, and considered by the commissioner under subsection (a)(1) through (a)(13) is subject to the requirements of IC 5-14-3. However, the commissioner's approval of a rate increase or decrease may take effect before the information compiled, prepared, and considered by the commissioner under subsection (a)(1) through (a)(13) is made accessible to the public under IC 5-14-3.

(d) When considering whether to approve a premium rate increase, the commissioner shall consider whether the current rate is appropriate for achieving the target loss ratio of the health maintenance organization.

(e) To the extent authorized by the Patient Protection and Affordable Care Act and other federal law, the commissioner, under this section, may:

(1) consider network adequacy;

(2) conduct form review to ensure:

(A) minimum essential health benefits; and

(B) nondiscriminatory benefit design;

(3) perform accreditation confirmation; and

(4) confirm quality measures.

As added by P.L.190-2023, SEC.34.