31.10.17.05

.05 Disclosure of Distribution of Premium Dollars.

A. The disclosure required under this regulation shall:

(1) Be in the form of a pie chart or bar graph; and

(2) Identify, in layman's terms, the proportion of every $100 in premium dollars that the carrier uses to pay:

(a) Providers for the provision of health care services to enrollees, including what proportion is for direct medical care expenses, and

(b) For plan administration.

B. The computation used in the pie chart or bar graph shall be in accordance with the National Association of Insurance Commissioners' instructions and formulas used in deriving the 5-year historical data page of the carrier's annual statement.

C. The pie chart or bar graph to be included in enrollment sales material shall be based on the annual statement of the:

(1) Immediate prior year for enrollment sales material used on or after July 1 of each year; and

(2) Year before the immediate prior year for enrollment sales material used before July 1 of each year.

D. The computation used under §B of this regulation shall be limited to benefits under policies which make health care services available through contracts with providers.