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§ 3801.303. Required filings

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: March 21, 2012

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 P.S. Insurance (Refs & Annos)
Chapter 18. Accident and Health Filing Reform Act (Refs & Annos)
Chapter 3. Federal Compliance (Refs & Annos)
Effective: March 21, 2012
40 P.S. § 3801.303
Formerly cited as PA ST 40 P.S. § 3803
§ 3801.303. Required filings
(a) Form filings.--Each insurer shall file with the department any form which it proposes to issue in this Commonwealth except a type or kind of form which, in the opinion of the commissioner, does not require filing. The form filings required by this section shall be made no less than 45 days, or a shorter period of time as the department may establish, prior to their effective dates. The filings shall be subject to filing and review in accordance with the provisions of section 304.1
(b) Notice of exemption from form filing.--The commissioner shall issue notice in the Pennsylvania Bulletin identifying any type or kind of form which has been exempted from filing. The commissioner may subsequently require the forms to be filed under this section upon notice published in the Pennsylvania Bulletin. Any such subsequent notice shall not be effective until 90 days after publication.
(c) Individual rates.--Each insurer shall file with the department rates for individual accident and health insurance policies which it proposes to use in this Commonwealth except those rates which, in the opinion of the commissioner, cannot practicably be filed before they are used. The commissioner shall publish notice in the Pennsylvania Bulletin identifying rates which the commissioner determines cannot practicably be filed. The filings required by this subsection shall be made no less than 45 days, or a shorter period of time as the department may establish, prior to their effective dates. The filings shall be subject to filing and review in accordance with the provisions of section 304.
(d) Certain group rates exempt.--Except as provided in subsection (e), an insurer shall not be required to file with the department rates for accident and health insurance policies which it proposes to issue on a group basis in this Commonwealth.
(e) Required group rate filings.--Each insurer shall file with the department rates for small group accident and health insurance policies which it proposes to issue on a group basis in this Commonwealth for other than excepted benefits as defined in section 2791(c) of the Public Health Service Act (110 Stat. 1972, 42 U.S.C. § 300gg-91(c)) in accordance with the following:
(1) Each insurer shall establish and file with the department prior to use a base rate which is not excessive, inadequate or unfairly discriminatory. The initial base rate for existing hospital plan corporations, professional health services plan corporations and HMOs shall be the rate or the rating formula currently on file and approved by the department as of the effective date of section 314.2 The initial base rate or base rating formula for any insurer with no base rate or base rating formula on file and approved as of the effective date of section 314 shall be the base rate or base rating formula in effect on the effective date of section 314, and shall be filed with the department no more than 45 days thereafter.
(2) Proposed changes to a base rate or base rating formula which effect an increase or decrease in the base rate or base rating formula of 10% or more annually in the aggregate shall be subject to filing and review by the department in accordance with the provisions of section 304. The filings required by this paragraph shall be made no less than 45 days, or a shorter period of time as the department may establish, prior to their effective dates.
(3) Proposed changes to a base rate or base rating formula which effect an increase or decrease in the base rate or base rating formula of less than 10% annually in the aggregate shall be filed with the department and may be used 45 days thereafter.
(4) Rates developed for a specific group which do not deviate from the base rate or base rate formula by more than 15% may be used without filing with the department.
(5) Rates developed for a specific group which deviate from the base rate or base rate formula by more than 15% shall be subject to filing and review in accordance with the provisions of section 304. The filings required by this paragraph shall be made no less than 45 days, or a shorter period of time as the department may establish, prior to their effective dates.
(6) The commissioner shall have discretion to exempt any type or kind of rate filing under this subsection by regulation except for filings required under subsection (c) and paragraph (2).
(f) Power of department.--The department may, at the discretion of the commissioner through notice in the Pennsylvania Bulletin, adjust the 10% threshold set forth in subsection (e)(2) and (3), only for purposes of coordinating the filing requirements of this section, to a state-specific percentage determined by the Secretary of the United States Department of Health and Human Services.

Credits

1996, Dec. 18, P.L. 1066, No. 159, § 3, effective in 60 days. Renumbered as § 303 and amended by 2011, Dec. 22, P.L. 615, No. 134, § 5, effective in 90 days [March 21, 2012].

Footnotes

40 P.S. § 3801.304.
40 P.S. § 3801.314.
40 P.S. § 3801.303, PA ST 40 P.S. § 3801.303
Current through 2017 Regular Session Act 82 (End)
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