| member months for which the rates will be in effect and the | basis for the estimate.__If the superintendent determines | that the number of member months is likely to be less than | 1,000 and the block does not satisfy any alternative | credibility standards adopted by rule, the filing is subject | to subsection 2-B. |
|
| B.__Within 7 months after the end of the period for which | rates are in effect, the carrier shall file a report with | the superintendent showing aggregate earned premiums and | incurred claims for the period the rates were in effect.__ | Incurred claims must include claims paid to a date 6 months | after the end of the period for which rates were in effect | and an estimate of unpaid claims.__The report must state how | the unpaid claims estimate was determined. |
|
| C.__If incurred claims were less than 80% of earned | premiums, the carrier shall refund a percentage of the | premium to an entity or person that paid the premium.__The | percentage must be the same for all groups and subgroups and | must be calculated as the ratio of excess premiums to | aggregate earned premiums.__Excess premiums must be | calculated by dividing the aggregate incurred claims by 0.8 | and subtracting the result from aggregate earned premiums.__ | The total of all refunds must equal the excess premiums. |
|
| D.__The superintendent may require further support for the | unpaid claims estimate and may require refunds to be | recalculated if the estimate is found to be unreasonably | large. |
|
| E.__The superintendent may adopt rules setting forth | appropriate methodologies regarding reports, refunds and | credibility standards pursuant to this subsection.__Rules | adopted pursuant to this subsection are routine technical | rules as defined in Title 5, chapter 375, subchapter 2-A. |
|
| | Sec. D-9. 24-A MRSA §2839, as amended by PL 1985, c. 648, §11, is | further amended to read: |
|
| | No policy of group health insurance may be delivered in this | State until a copy of the group manual rates to be used in | calculating the premium for these policies has been filed for | informational purposes with the superintendent. Notwithstanding | this section, rates for group Medicare supplement, nursing home | care or long-term care insurance contracts must be filed in | accordance with section 2736 and rates for small group health |
|
|