CA Ins Code Section 10181.3

(a)

All health insurers shall file with the department all required rate information for individual and small group health insurance policies at least 60 days prior to implementing any rate change.

(b)

An insurer shall disclose to the department all of the following for each individual and small group rate filing:

(1)

Company name and contact information.

(2)

Number of policy forms covered by the filing.

(3)

Policy form numbers covered by the filing.

(4)

Product type, such as indemnity or preferred provider organization.

(5)

Segment type.

(6)

Type of insurer involved, such as for profit or not for profit.

(7)

Whether the products are opened or closed.

(8)

Enrollment in each policy and rating form.

(9)

Insured months in each policy form.

(10)

Annual rate.

(11)

Total earned premiums in each policy form.

(12)

Total incurred claims in each policy form.

(13)

Average rate increase initially requested.

(14)

Review category: initial filing for new product, filing for existing product, or resubmission.

(15)

Average rate of increase.

(16)

Effective date of rate increase.

(17)

Number of policyholders or insureds affected by each policy form.

(18)

The insurer’s overall annual medical trend factor assumptions in each rate filing for all benefits and by aggregate benefit category, including hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology. An insurer may provide aggregated additional data that demonstrates or reasonably estimates year-to-year cost increases in specific benefit categories in the geographic regions listed in Sections 10753.14 and 10965.9. For purposes of this paragraph, “major geographic region” shall be defined by the department and shall include no more than nine regions.

(19)

The amount of the projected trend attributable to the use of services, price inflation, or fees and risk for annual policy trends by aggregate benefit category, such as hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology.

(20)

A comparison of claims cost and rate of changes over time.

(21)

Any changes in insured cost sharing over the prior year associated with the submitted rate filing.

(22)

Any changes in insured benefits over the prior year associated with the submitted rate filing.

(23)

The certification described in subdivision (b) of Section 10181.6.

(24)

Any changes in administrative costs.

(25)

Any other information required for rate review under PPACA.

(c)

An insurer subject to subdivision (a) shall also disclose the following aggregate data for all rate filings submitted under this section in the individual and small group health insurance markets:

(1)

Number and percentage of rate filings reviewed by the following:

(A)

Plan year.

(B)

Segment type.

(C)

Product type.

(D)

Number of policyholders.

(E)

Number of covered lives affected.

(2)

The insurer’s average rate increase by the following categories:

(A)

Plan year.

(B)

Segment type.

(C)

Product type.

(3)

Any cost containment and quality improvement efforts since the insurer’s last rate filing for the same category of health benefit plan. To the extent possible, the insurer shall describe any significant new health care cost containment and quality improvement efforts and provide an estimate of potential savings together with an estimated cost or savings for the projection period.

(d)

The department may require all health insurers to submit all rate filings to the National Association of Insurance Commissioners’ System for Electronic Rate and Form Filing (SERFF). Submission of the required rate filings to SERFF shall be deemed to be filing with the department for purposes of compliance with this section.

(e)

A health insurer shall submit any other information required under PPACA. A health insurer shall also submit any other information required pursuant to any regulation adopted by the department to comply with this article.