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PA Bulletin, Doc. No. 11-1296

NOTICES

INSURANCE DEPARTMENT

Advisory Notice—Rate Review Process Determination; Notice No. 2011-06

[41 Pa.B. 4179]
[Saturday, July 30, 2011]

 This notice is issued to all persons and entities impacted by the Accident and Health Filing Reform Act (act) (40 P. S. §§ 3801—3815) concerning the review process for rates in the individual and small group markets. On July 1, 2011, the Federal Department of Health and

Human Services, Center for Consumer Information and Insurance Oversight (CCIIO), issued a letter setting forth its ''effective rate review program determination.'' A copy of the letter can be found at http://www.portal.state.pa. us/portal/server.pt/document/1093572/hhs_rate_review_ determination_pdf.

 As set forth in the determination letter, CCIIO concluded that based on the Federal criteria, the Commonwealth does not currently have an ''effective rate review program'' in place for the small group market. As a result, for small group market filings effective on or after September 1, 2011, affected insurers will need to comply with applicable Federal requirements unless and until rating laws in this Commonwealth for the small group market are determined to be effective.

 The act, however, remains in effect. Rates required by the act to be filed with the Insurance Department (Department) must continue to be filed with the Department, regardless of whether they must also be submitted to CCIIO. Thus:

 - An entity proposing to use a rate for an individual accident and health insurance policy in this Commonwealth must file it with the Department as required under section 3(c) of the act, 40 P. S. § 3803(c). If the rate is subject to review under section 2794 of the Public Health Service Act (40 U.S.C.A. § 300gg-94), and its regulation in 45 CFR 154.101—154.301, the entity also must submit Parts I and II of the Preliminary Justification as required under 45 CFR 154.215 (relating to submission of disclosure to CMS for rate increases subject to review) to the Centers for Medicare and Medicaid Services (CMS) and to the Department.

 - A hospital plan corporation, professional health services plan corporation or health maintenance organization proposing to use a rate for a group accident and health insurance policy in this Commonwealth must file it with the Department if required under section 3(e) of the act. If the rate is subject to review under section 2794 of the Public Health Service Act and its regulations in 45 CFR 154.101—154.301, the entity also must submit Parts I and II of the Preliminary Justification as required under 45 CFR 154.215 to CMS and to the Department, and must submit Part III of the Preliminary Justification to CMS.

 Questions regarding this notice may be addressed to the Life, Accident and Health Bureau, Attn: Rate Review Process, Insurance Department, 1311 Strawberry Square, Harrisburg, PA 17120 by letter or ra-rateform@ state.pa.us.

MICHAEL F. CONSEDINE, 
Insurance Commissioner

[Pa.B. Doc. No. 11-1296. Filed for public inspection July 29, 2011, 9:00 a.m.]


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