TN Insurance Bulletin (1988-09-01): HMO'S - Filing of Rates

STATE OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE 500 JAMES ROBERTSON PARKWAY NASHVILLE, TENNESSEE 37219 NED McWHERTER GOVERNOR ELAINE A. McREYNOLDS COMMISSIONER r'\." .. . } ' .... - . B U L L E T I N TO: All Heal th Maintenance Organizations FR: Elai ne A. McReynolds, Commissioner ~/11 Depar tme nt of Commerce and Insurance RE: HMO'S - Filing of Rates DA: Sept embe r 1, 1988 It h as come to the attention of the Department that some HMO's are no t filing their schedule of charges for enr ollee coverage with the Department for approval. T.C.A . Section 56- 32-207(b) pr ovides in pertinent part that no schedul e of charges f or enrollee coverage for health care services , 2..!:. amendment thereto may be used until a copy of s uch schedule, or amendment thereto, has been filed and app roved by the commissio ner. Such ch arges may be established in acc ordance with actuarial pr inciples for various categories o f enroll ees, provided that charges applicable to an · enrollee shall no t be individua lly determined based on the status o f his hea lth. However, the charges shall not be excessive, inadequate , or unfairly dis criminatory. A certification by a quali fied actuary or other qualified person acceptab le to the commissioner of the appropriateness of the use of the charges, based on rea sonable assumptions, shall accompa ny the fi ling along wit h a dequate supporting information. The commissi oner shall app rove such charges within a reasonable pe riod of t ime. Any HMO failing to comply with T.C.A. 56-32- 207(b) sh ould immediate ly c ome into compliance. EAM/cmf