31.13.01.08

.08 Premium Rates by Case Method.

A. Vacant.

B. Vacant.

C. Case Comprised of Two or More Accounts.

(1) If an insurer has combined two or more accounts to establish a case, it may not add additional accounts or remove accounts from that case except with the permission of the Commissioner and under conditions which the Commissioner may specify.

(2) When submitting an experience report for a case comprised of two or more accounts, the insurer shall include a list of the names of each account included in the case.

D. Premium rates for each case shall be established by the insurer to afford a loss ratio of at least 55 percent if the resulting rates do not exceed prima facie premium rates, and may be established in accordance with the methods of Regulation .18 of this chapter if the substitution of prima facie premium rates would result in a loss ratio in excess of 55 percent.

E. If an insurer acquires an existing account for which rates were established by another insurer by the case method, the new insurer shall use the same rates or rates not greater than those which were approved for use by the former insurer until the end of the existing experience period established by the former insurer. In reporting this account at the end of the experience period, the new insurer shall combine the experience of the former insurer with its own experience for the term of the experience period in order to determine subsequent rates for the account.

F. Reports for each case shall be submitted by the insurer at the end of each experience period, together with a statement of the then applicable premium rates proposed by the insurer. If the premium rates proposed by the insurer for the case do not meet the loss ratio standards of §D of this regulation, the insurer shall make an appropriate premium reduction, to be effective on or before 45 days after the date of filing of the experience report, unless, for good cause shown, the Commissioner approves a higher premium rate. If the insurer does not propose to reduce premium rates in accordance with these regulations, the Commissioner shall notify the insurer and afford it a hearing. The Commissioner shall notify the insurer in writing within 60 days of the filing of the experience report of the Commissioner's findings in regard to the premium rate which the Commissioner determines should be charged. The insurer shall implement the rates determined by the Commissioner not later than 45 days after receipt of the Commissioner's notice of the rates which the Commissioner authorizes for the case.

G. Credit Health Insurance — Case Experience and Application of Rate Adjustment Factor.

(1) If a plan of benefits for credit health insurance qualifies as a case, whether consisting of accounts of one or more creditors, the case experience submitted by the insurer at the end of the experience period shall include the experience of all plans of benefits for credit health insurance written by creditors comprising the case.

(2) If the experience of the case results in a downward rate adjustment, the insurer shall apply the rate adjustment factor to all plans of benefits for credit health insurance written by the creditors comprising the case.

(3) If the experience of the case results in an upward rate adjustment, the insurer may apply the rate adjustment factor to all plans of benefits for credit health insurance written by the creditors comprising the case.