58-18B-15 Provisions for premium rates.
Provisions for premium rates.
Premium rates for health benefit plans subject to
this chapter are subject to the following provisions:
Adjustments in rates for claim experience, health status, and duration of coverage may not
be charged to individual employees or dependents. Any such adjustments shall be applied
uniformly to the rates charged for all employees and dependents of the small employer;
A small employer carrier may utilize industry as a case characteristic in establishing
premium rates, if the highest rate factor associated with any industry classification does
not exceed the lowest rate factor associated with any industry classification by more than
Small employer carriers shall apply rating factors, including case characteristics,
consistently with respect to all small employers in a class of business;
For the purposes of this section, a health benefit plan that utilizes a restricted provider
network is not considered similar coverage to a health benefit plan that does not utilize
such a network, if utilization of the restricted provider network results in substantial
differences in claims costs; and
No small employer carrier may use case characteristics, other than age, gender, industry,
family composition, and group size without prior approval of the director.
SL 1995, ch 281, § 8.