Restrictions Relating To Premium Rates

The following provisions are applicable for all individual health benefit plans. (3-31-22) 01. Rate Manual. An individual carrier develops a rate manual for all individual business. Base premium rates and new business premium rates charged to eligible individuals by the individual 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 an individual 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. An individual carrier will not modify the rating method used in the rate manual for its individual 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 an individual carrier to determine premium rates for health benefit plans in its individual business (an individual carrier 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 method of allocating expenses among health benefit plans; or (3-31-22) c. A change in a rating factor with respect to any case characteristic if the change would produce a change in premium for any individual that exceeds ten percent (10%). (3-31-22) d. 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 an individual 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 an individual a separate application fee, underwriting fee, or any other separate fee beyond the premium for a 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) IDAHO ADMINISTRATIVE CODE IDAPA 18.04.13 Department of Insurance Individual Health Insurance Availability Act Rules Section 046 Page 8 037. -- 045. (RESERVED)