CHAPTER Ins 4400 STOP LOSS
INSURANCE
Statutory Authority: RSA 400-A:15, I; RSA 415-H:5
PART Ins 4401 ACTUARIAL CERTIFICATION
Ins 4401.01 Purpose and Scope.
(a) The purpose of
this part is to establish criteria for actuarial certification that the insurer
is in compliance with RSA 415-H.
(b) This part shall
apply to all accident and health insurers licensed to do business in this
state.
Source. #9244, eff 9-2-08; ss by #11149, eff 9-2-16
Ins 4401.02 Definitions.
(a) "Actuarial
certification" means "actuarial certification" as defined in RSA
415-H:2, I.
(b) "Attachment
point" means "attachment point" as defined in RSA 415-H:2, II.
(c) "Expected
claims" means "expected claims" as defined in RSA 415-H:2, III.
Source. #9244, eff 9-2-08; ss by #11149, eff 9-2-16
Ins 4401.03 Actuary Criteria; Change of
Actuary.
(a) The board of
directors of each stop loss insurer shall appoint an actuary responsible for
the filing of the actuarial certification required by RSA 415-H.
(b) The actuary
shall meet the requirements of Ins 2401.04 (b) and (c).
(c) The insurer
shall immediately notify the commissioner if the insurer changes the actuary
responsible for the annual certification.
(d) The notice
provided in (c) above shall disclose the reason for the change.
Source. #9244, eff 9-2-08; ss by #11149, eff 9-2-16
Ins 4401.04 Certification by
Actuary: Polices Issued or Renewed Between
January 1, 2017 and January 1, 2021.
For the purposes of actuarial certification, the actuary shall perform
the following duties for policies issued or renewed on or after January 1, 2017
and until January 1, 2021:
(a) Certify that the
insurer has not issued or renewed any stop loss policy with an annual
attachment point for claims incurred per individual that is less than $27,500;
(b) Certify that the
insurer has not issued or renewed any stop loss policy to any employer group
having 50 or fewer covered employee members with an aggregate attachment point
that is less than the greater of the following:
(1) Fifty-five hundred dollars times the number
of covered lives;
(2) One hundred twenty percent of expected
claims; or
(3) Twenty-seven thousand and five hundred dollars;
(c) Certify that the
insurer has not issued or renewed any stop loss policy to any employer group
having 51 or more covered employee members with an aggregate attachment point
that is less than 110 percent of expected claims;
(d) Certify that the
actuary's examination included a review of the appropriate records and the actuarial
assumptions and methods used by the insurer in establishing attachment points
and other applicable determinations in conjunction with the provision of stop
loss insurance coverage;
(e) Certify that the
methods used to calculate the number of covered employee members and the number
of covered members is consistent across the insurer's business in this state
and no changes have been made in these methods in the past 5 years;
(f) File an
actuarial certification with the board of directors of the insurer and with the
commissioner;
(g) Promptly notify
the commissioner and the board of directors of the insurer of any error in a
previous certification; and
(h) Promptly notify
the commissioner and the board of directors of the insurer when the actuary
cannot provide the actuarial certifications as required.
Source. #9244, eff 9-2-08; ss by #11149, eff 9-2-16;
ss by #13095, eff 8-28-20
Ins 4401.05 Certification by Actuary: Policies Issued or Renewed On or After
January 1, 2021. For the purposes of actuarial certification,
the actuary shall perform the following duties for policies issued or renewed
on or after January 1, 2021:
(a) Certify that the insurer has not issued or renewed any stop loss policy
with an annual attachment point for claims incurred per individual that is less
than $31,000;
(b) Certify that the insurer has not issued or
renewed any stop loss policy to any employer group having 50 or fewer covered
employee members with an aggregate attachment point that is less than the
greater of the following:
(1)
Sixty-two hundred dollars times the number of covered lives;
(2)
One hundred twenty percent of expected claims; or
(3)
Thirty-one thousand dollars;
(c) Certify that the insurer has not issued or
renewed any stop loss policy to any employer group having 51 or more covered
employee members with an aggregate attachment point that is less than 110
percent of expected claims;
(d) Certify that the actuary's examination
included a review of the appropriate records and the actuarial assumptions and
methods used by the insurer in establishing attachment points and other applicable
determinations in conjunction with the provision of stop loss insurance coverage;
(e) Certify that the methods used to calculate
the number of covered employee members and the number of covered members is
consistent across the insurer's business in this state and no changes have been
made in these methods in the past 5 years;
(f) File an actuarial certification with the
board of directors of the insurer and with the commissioner;
(g) Promptly notify the commissioner and the
board of directors of the insurer of any error in a previous certification; and
(h) Promptly notify the commissioner and the
board of directors of the insurer when the actuary cannot provide the actuarial
certifications as required.
Source. #9244, eff 9-2-08; ss by #11149, eff 9-2-16
(from Ins 4401.04); ss by #13095, eff 8-28-20
Ins 4401.06 Term
of Certification and Annual Filing.
(a) The actuarial
certification period shall be coterminous with a calendar year.
(b) The actuarial
certification shall be submitted to the commissioner annually, to the attention
of the life, accident and health insurance division, on or before March 15
following the period for which the actuarial certification is being made
pursuant to RSA 415-H:4.
Source. #11149, eff
9-2-16 (from Ins 4401.05)
Appendix
Rule
|
Specific State Statute the Rule
Implements
|
|
|
Ins 4401.01 |
RSA 400-A:15, I; RSA
415-H:1 |
Ins 4401.02 |
RSA 400-A:15, I; RSA
415-H:2; RSA 415-H:3 |
Ins 4401.03 |
RSA 400-A:15, I; RSA
415-H:2; RSA 415-H:4 |
Ins 4401.04 |
RSA 400-A:15, I; RSA
415-H:2; RSA 415-H:4 |
Ins 4401.05 |
RSA 400-A:15, I; RSA
415-H:2; RSA 415-H:4 |
Ins 4401.06 |
RSA 400-A:15, I; RSA
415-H:2; RSA 415-H:4 |