R590-283-5. Unified Rate Review Template, Rate Data Template, and Plans and Benefits Template Modifications

(1) A carrier that expects to be eligible to receive a defrayal payment shall modify a federal rate filing template as follows: (a) exclude the expected defrayal payment from the rates submitted on both the Unified Rate Review Template and the Rate Data Template; (b) indicate in the rate filing's actuarial memorandum: (i) whether the carrier anticipates a defrayal payment from the state for the cost of an eligible state-required benefit; (ii) that the cost of the state-required benefit is not included in the premiums; and (iii) the defrayal payment amount the carrier expects to receive; and (c) indicate in the "Benefits Information" field on the Plans and Benefits Template that the carrier covers the state-required benefits, selecting the state-required benefit of "Not EHB" for the "EHB Variance Reason" field. (2)(a) A carrier may not factor a state-required benefit into the calculation for the "EHB Percent of Total Premium" field on the Plans and Benefits Template. (b) A state-required benefit may not be included in the total premium from which the "EHB Percent of Total Premium" field is calculated.