Speed to Market Tools for Individual and Small Group Non ...



Speed to Market Tools for Individual and Small Group Non-Pediatric Dental Only and Vision Only Plan Rate FilingsPurpose: Speed to Market (STM) Tools provide guidance for preparing a filing. Although using the information in this document does not guarantee that your filing will be approved, it will expedite the review of your filing.Who should use this document?Applicable Licenses: HCSCs, HMOs and Disability Issuers.Applicable TOIs: H10G, H10I, H20G, and H20I.Other Information: Dental coverage that does not include Stand Alone Pediatric Dental (SAPD) coverage.Speed to Market InformationGeneral InformationNot-for-public and for-public rate filings:The company may, at its option, submit either one (combined Public/Not-For-Public) filing or two filings (Public and Not-For-Public). If the company is submitting two filings, it should include in the Not-For-Public filing a request for the filing to be confidential in accordance with RCW 48.02.120(3)The Public Filing should include at least the Rate Schedule in II.A and its supporting Actuarial Certification. Speed to Market Instructions and GuidanceOn the Rate/Rule Schedule tab in SERFFRates and Rate Adjustment FactorsProvide a Rate Schedule that lists all the plans (new and renewing) and their corresponding base rates. [WAC 284-43-6100(1), and WAC 284-43-6020(4) and (37)]Provide the rate manual including base rate adjustment factors. [WAC 284-43-6100(5) and WAC 284-6020(31)] On the Supporting Documents tab in SERFF as part of the Actuarial MemorandumPlan InformationAre all the company’s small group/individual renewal plans included in this filing? Are all the company’s new small group/individual plans included in this filing?The company is allowed to include New Plans in its pool rate change filing or file separately from its pool rate change filing.Provide a list of all new and renewal Plan Names included in this Rate filing. Indicate which plans are new or renewing plans in the list.Provide a Table showing all Benefit and/or Cost-Sharing changes from last rate filing for renewal plans; if none, please state that no changes have been made to benefits or cost-sharing from previous filing.Matching Form Filings to the rate filingAfter your rate filing is filed, we will ask you to provide a table reflecting the following information: For each plan filed in the rate filing, list the most recent form filing SERFF Tracker ID or the corresponding form filing SERFF Tracker ID. Base Rate Development DocumentationAre Base Rate defined according to WAC 284-43-6020(4)? Base Rate” means the “Premium” for a specific “plan,” expressed as a monthly amount per “covered person or subscriber,” prior to any adjustments for geographic area, age, family size, wellness activities, tenure, or any other factors as may be allowed. For small group filings, describe in detail how your Base Rate for each plan reflects the definition according to WAC 284-43-6020(4), and the base rate development does not double count the rate adjustment factors (e.g., age factor, demographic factor etc.), so that when the adjustment factors are applied to each plan’s Base Rate, an appropriate premium for the group is generated based on its profile. Adjustment Factor Information DocumentationAre there any new or changes to previously filed base rate adjustment factors included in the rate filing?List all the base rate adjustment factor types included in the filing (e.g., geographic region, age, family size). For each type of adjustment factor:Indicate if the set of factors are new, changing, or remain the same as the last rate filing.For new adjustment factors, provide the justification and development information in the rate development documentation referenced below.1.3 The regulations do not allow premium discounts for purchase of multiple coverages (e.g., Dental and Vision products purchased simultaneously). For changing adjustment factors, provide the corresponding rate impact and revenue neutral calculation. Provide the justification and development information for the change in the rate development documentation referenced below.Rate Development DocumentationPer WAC 284-43-6100, filings for individual plans must include each individual plan rate schedule, and filings for small group plans must include base rates and annual base rate changes in dollar and percentage amounts for each small group plan. Each individual and small group filing must include the following information and documents:Per WAC 284-43-6100, the experience of all Individual and all Small Group Plans must be pooled. It is very important to note that OIC’s review of rate filings specifically looks for compliance with this requirement. In this regard, OIC considers:Experience refers not only to claims experience but also to expenses;If the company has WA experience for the product line and it is considered credible (viewing both the recent history and volume), it must be pooled and a pooled rate change established for the rating period. The pooled rate increase can be lower than that required, if the company chooses. The pooled rate increase should either be (a) allocated uniformly over all plans in the filing or (b) justified by each plan’s benefit relativity. If the company decide to adjust the rate based on each plan’s benefit relativity, the company must include a demonstration of “revenue neutrality” which shows that the projected revenues from (iii) (a) and (iii) (b) above are the same. (1) (i) to (iii) methodology above also applies to carriers new to the WA market or lacking credible experience on rate development under “pooled” approach following the determination of a pool rate for the rating period appropriate sources (see below). For definitions (e.g., Base Rates, Premium Rate Schedule, etc.), see WAC 284-43-6020 and WAC 284-43-6520.Provide the following information about the WA Individual/Small Group Risk Pool Experience Period:Beginning and End date of twelve month time period;Member months;Premiums;Claims;Administration expenses;Commissions;Premium tax;Other taxes (specify); andLoss or Profit.Provide the financial information in both dollars and PMPM. Show the loss ratio. Note while some carriers prefer to work with PSPM (Per Subscriber Per Month) calculations, for our review presentations, a PMPM approach is preferred.Per WAC 284-43-6100(1)(a), describe your rate-making methodology. This would ideally start with the risk pool experience and proceed to projecting rating period outcomes, recognizing trend, benefit and cost-share changes and other factors to develop the Rate Schedule for each plan.If the company is new to WA market or does not have credible prior history (WA or otherwise), the company may use a manual rate approach either from your own data (e.g., adjusted national data) or based on vendor-purchased data. Please describe in detail the approach used, any adjustments made to the data to reflect WA expectations and justification for why it is appropriate.The Actuarial Certification must state the extent of reliance by the opining Actuary on any external data.Per WAC 284-43-6100, please provide the details indicated in WAC 284-43-6100(1) through (6). For subsection (5) in particular, state which of the adjustments the company has proposed are standard for the Industry and which are not. For the latter, please include justification for why the company believes that it is appropriate, and provide data in support per WAC 284-43-6100(5)(b). Ensure your documentation addresses the credibility of the data used to develop these estimates and factors.Trend assumption: Provide justification for your trend assumption, including recent historical trend outcomes.Expenses: Provide two year historical PMPMs for detailed itemized fixed and variable administration costs. Also provide the rate development assumptions for these categories used in the prior rate filing.For the requirements in WAC 284-43-6100(1) through (6), if the company is seeking an exemption as permitted by WAC 284-43-6100(7), please provide the justification for each requirement in WAC 284-43-6100(1) through (6).Include an Excel spreadsheet and a PDF file of the contents of the excel spreadsheet showing the assumptions and development of the rates. Name the Excel file identically to the name of the PDF filing but add the word “DUPLICATE” at the end of file name.The Excel file should include all formulas that help track the development of the Base Rates and adjustment factors. Attach a completed filing summary for WAC 284-43-6660.Use the Format - Rates - WAC 284-43-6660 Summary Duplicate document (provided on the OIC website).Provide an Actuarial Certification that the rates are reasonable in relation to the premium, having met the requirements of WAC 284-43-6040(2). Please state any reliance on work of others.For small group, provide a sample premium calculation. In the interest of simplicity, use a maximum group size of 5 employees and at least 80% of the base rate adjustment factors.Contact UsFor filing related questions, contact the Rates, Forms, and Provider Networks (RFPN) Help Desk:(360) 725-7111rfhelpdesk@oic.For feedback or suggestions, email us:RFHealthplan@oic. ................
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