R590-167-3. Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows: (1) "Act" means Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act. (2) "Change in a rating factor" means the cumulative change of a rating factor over a 12-month period. (3) "Change in rating method" means: (a) a change in the number of case characteristics used to determine health benefit plan premium rates in a class of business; (b) a change in the manner or procedure by which an insured is assigned into a category for applying a case characteristic to determine health benefit plan premium rates in a class of business; (c) a change in the method of allocating expenses among health benefit plans in a class of business; or (d) a change in one or more rating factors for any case characteristic if the change produces a change in premium for an individual or small employer that exceeds 10%. (4) "New entrant" means an eligible employee, or a dependent of an eligible employee, who becomes part of a small employer group after the initial period for enrollment in a health benefit plan. (5) "Risk characteristic" means a rating factor related to the demographics, health status, or experience of an individual, a small employer, or a member of a small employer group, other than a case characteristic under Section 31A-30-106 or 31A-30-106.1, as applicable, including: (a) exact age; (b) gender; (c) family composition; (d) health status; (e) claims experience; (f) duration of coverage; or (g) any similar characteristic. (6) "Risk load" means the percentage above the base premium rate charged by a covered carrier to a covered insured reflecting the risk characteristics of the covered individual.