Home Table of Contents

§ 981-7. Excessive loss provision

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. Insurance

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 P.S. Insurance (Refs & Annos)
Chapter 2. Insurance Companies (Refs & Annos)
Article X-a. Health Care Insurance Individual Accessibility
40 P.S. § 981-7
§ 981-7. Excessive loss provision
Currentness
(a) At any time, the designated insurer may file for a rate adjustment for products offered under section 1005-A with the commissioner in accordance with the act of December 18, 1996 (P.L. 1066, No. 159),1 known as the “Accident and Health Filing Reform Act.”
(b) The designated insurer may request that the commissioner conduct a hearing if:
(1) the losses experienced by the designated insurer on products offered under section 1005-A(a)(1)2 or by eligible individuals under section 1005-A(a)(2) require a rate increase of greater than twenty per centum (20%) and the losses are in excess of a one hundred ten per centum (110%) medical loss ratio for any calendar year; or
(2) the designated insurer requested a rate increase for products under section 1005-A(a) and has reason to believe that continuation as a designated insurer will have a detrimental impact on its financial condition or solvency.
(c) Upon the request of a designated insurer under subsection (b), the commissioner shall conduct a public hearing regarding the rate filing, medical loss ratio or the impact that being a designated insurer is having on the designated insurer's solvency. The hearing shall be held as provided for in 2 Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of Commonwealth agencies). Following the hearing, the commissioner shall determine the extent of the impact, if any, of being a designated insurer under this article on the designated insurer's rate filing, medical loss ratio, overall operations and solvency, and shall do one or more of the following:
(1) grant, modify or deny the requested rate filing; or
(2) request to withdraw from the approved alternative mechanism and to authorize implementation of the Federal default standards set forth in section 2741 of the Federal act.

Credits

1921, May 17, P.L. 682, No. 284, § 1007-A, added 1997, Nov. 4, P.L. 492, No. 51, § 4, effective Jan. 1, 1998.

Footnotes

1
40 P.S. § 3801.101 et seq.
2
40 P.S. § 981-5(a)(1).
40 P.S. § 981-7, PA ST 40 P.S. § 981-7
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
End of Document