Restrictions Relating To Premium Rates

The following provisions are applicable for all small employer health benefit plans. (3-31-22) 01. Separate Rate Manual for Each Class of Business. A small employer carrier develops a separate rate manual for each class of business. Base premium rates and new business premium rates charged to small employers by the small employer carrier are computed solely from the applicable rate manual developed pursuant to this Section. To the extent that a portion of the premium rates charged by a small employer carrier is based on the carrier’s discretion, the manual specifies the criteria and factors considered by the carrier in exercising such discretion. (3-31-22) 02. Requirements for Adjustments to Rating Method. A small employer carrier will not modify the rating method used in the rate manual for a class of business until the change has been approved as provided in this Section. The Director may approve a change to a rating method if the Director finds that the change is reasonable, actuarially appropriate, and consistent with the purposes of the Act and this chapter. (3-31-22) 03. Change in Rating Method. For the purpose of this Section, a change in rating method means: (3-31-22) a. A change in the number of case characteristics used by a small employer carrier to determine premium rates for health benefit plans in a class of business (a small employer will not use case characteristics other than age, individual tobacco use, geography or gender without prior approval of the Director); (3-31-22) b. A change in the manner or procedures by which insureds are assigned into categories for the purpose of applying a case characteristic to determine premium rates for health benefit plans in a class of business; (3-31-22) c. A change in the method of allocating expenses among health benefit plans in a class of business; or (3-31-22) d. A change in a rating factor with respect to any case characteristic if the change would produce a change in premium for any small employer that exceeds ten percent (10%). (3-31-22) e. For the purpose of this Subsection, a change in a rating factor means the cumulative change with respect to such factor considered over a twelve (12) month period. If a small employer carrier changes rating factors with respect to more than one case characteristic in a twelve (12) month period, the carrier considers the cumulative effect of all such changes in applying the ten percent (10%) test. (3-31-22) 04. Application Fee, Underwriter Fee, or Other Fees. A carrier will not charge a small employer or IDAHO ADMINISTRATIVE CODE IDAPA 18.04.12 – Small Employer Department of Insurance Health Insurance & Availability Act Rules Section 046 Page 9 employee a separate application fee, underwriting fee, or any other separate fee beyond the premium for the health benefit plan. (7-1-26) 05. Rate Manual to be Maintained for a Period of Six Years. Each rate manual developed pursuant to Subsection 036.01 is maintained by the carrier for a period of six (6) years. Updates and changes to the manual are maintained with the manual. (3-31-22) 06. Waiver Request for a Taft-Hartley Trust. A representative of a Taft-Hartley trust (including a carrier upon the written request of such a trust) may file a written request with the Director for the waiver of application of the provisions of Section 41-4706(1), Idaho Code, with respect to such trust. (3-31-22) 07. Provisions for Which Trust Is Seeking Waiver. A request made under Subsection 036.16 identifies the provisions for which the trust is seeking the waiver and describes, with respect to each provision, the extent to which application of such provision would: (7-1-26) a. Adversely affect the participants and beneficiaries of the trust; and (3-31-22) b. Require modifications to one (1) or more of the collective bargaining agreements under or pursuant to which the trust was or is established or maintained. (3-31-22) 08. Waiver Not for an Individual or Associate Member. A waiver granted under this provision will not apply to an individual who participates in the trust because the individual is an associate member of an employee organization or the beneficiary of such an individual. (3-31-22) 037. -- 045. (RESERVED)