3 Colo. Code Regs. § 702-4-2-78-6
Current through Register Vol. 47, No. 24, December 25, 2024
Section 3 CCR 702-4-2-78-6 - 87% CSR Enhancement Payments to CarriersA. Pursuant to C.R.S. § 10-16-1205(1)(b)(II), the Colorado Health Insurance Affordability Enterprise created in C.R.S. § 10-16-1204(1)(a), through the Division, will make payments to carriers by June 30, 2026 for the 2025 benefit year, and by June 30 of subsequent calendar years, to compensate for the difference between the 94% AV plan variant projected claims costs the carrier paid during the benefit year because of the CSR enhancement, and the 87% AV plan variant projected claims costs the carriers would have paid absent the CSR enhancement for the previous benefit year. Pursuant to Section 5.B., payments to carriers will not reflect expected changes in induced demand based on the 94% AV plan variant as compared with the 87% AV plan variant.B. The Division will calculate carrier payment amounts by determining the difference between what the carrier expects to pay in standard silver claims costs for plans with a 94% AV and the standard claims costs for plans with an 87% AV, using the following methodology. 1. A Silver Plan Claims Cost for a standard silver plan will be calculated as follows: Click to view image
a. The Incurred Claims as a Percent of Premium will be calculated as the URRT Worksheet 2, Total, line 4.15 divided by URRT Worksheet 2, Total, Line 4.17.b. The CSR Load will be determined from the information provided in the Supplemental Template filed in the annual rate filing as set forth in Colorado Insurance Regulation 4-2-39, Section 6.C.3 available in SERFF.2. An 87% AV Silver Claims Cost will be calculated as follows: Click to view image
a. The Silver Plan Claims Cost will be determined by the calculation in subsection 6(B)(1).b. The Adjusted AV of the 87% CSR Variant will be calculated by the formula: Metal AV X Silver 87% CSR Metal AV Adjustment Factor
(1) The Metal AV will be determined as follows: If the plan design is unique, the AV of the 87% CSR Variant will be determined by the value entered in the Issuer Actuarial Value in the carrier's PBT. Otherwise, the AV of the 87% CSR Variant will be determined by the value entered in the AV Calculator Output Number in the carrier's PBT.
(2) Section 7 provides the Silver 87% CSR Metal AV Adjustment Factor used in this calculation.c. The Adjusted AV of the Standard Silver On-Exchange Plan will be calculated by the formula: Metal AV X Silver Base (70%) Metal AV Adjustment Factor
(1) The Metal AV will be determined as follows: If the plan design is unique, the AV of the Standard Silver On-Exchange Plan will be determined by the value entered in the Issuer Actuarial Value in the carrier's PBT. Otherwise, the AV of the Standard Silver On-Exchange Plan will be determined by the value entered in the AV Calculator Output Number in the carrier's PBT.
(2) Section 7 provides the Silver Base (70%) Metal AV Adjustment Factor used in this calculation.d. The Induced Demand for the 94% CSR Variant will be determined using the adjusted actuarial value in subsection 6(B)(3)(b) in the induced demand factor formula from the risk adjustment methodology pursuant to 45 C.F.R. § 153.320(a)(1).e. The Induced Demand for a Standard Silver Plan will be determined using the adjusted actuarial value in subsection 6(B)(2)(c) in the induced demand factor formula from the risk adjustment methodology pursuant to 45 C.F.R. § 153.320(a)(1).3. A 94% AV Silver Claims Cost will be calculated as follows: Click to view image
a. The Silver Plan Claims Cost will be determined by the calculation in subsection 6(B)(1).b. The Adjusted AV of the 94% CSR Variant will be calculated by the formula: Metal AV X Silver 94% CSR Metal AV Adjustment Factor
(1) The Metal AV will be determined as follows: If the plan design is unique, the AV of the 94% CSR Variant will be determined by the value entered in the Issuer Actuarial Value in the carrier's PBT. Otherwise, the AV of the 94% CSR Variant will be determined by the value entered in the AV Calculator Output Number in the carrier's PBT.
(2) Section 7 provides the Silver 94% CSR Metal AV Adjustment Factor used in this calculation.c. The Adjusted AV of the Standard Silver On-Exchange Plan will be calculated by the formula: Metal AV X Silver Base (70%) Metal AV Adjustment Factor
(1) The Metal AV will be determined as follows: If the plan design is unique, the AV of the Standard Silver On-Exchange Plan will be determined by the value entered in the Issuer Actuarial Value in the carrier's PBT. Otherwise, the AV of the Standard Silver On-Exchange Plan will be determined by the value entered in the AV Calculator Output Number in the carrier's PBT.
(2) Section 7 provides the Silver Base (70%) Metal AV Adjustment Factor used in this calculation.d. The Induced Demand for the 94% CSR Variant will be determined using the adjusted actuarial value in subsection 6(B)(3)(b) in the induced demand factor formula from the risk adjustment methodology pursuant to 45 C.F.R. § 153.320(a)(1).e. The Induced Demand for a Standard Silver Plan will be determined using the adjusted actuarial value in subsection 6(B)(2)(c) in the induced demand factor formula from the risk adjustment methodology pursuant to 45 C.F.R. § 153.320(a)(1).4. The Payment to Carriers will be calculated as follows, for each eligible member during each month the member is enrolled (i.e., Per Member Per Month, or PMPM): Payment to Carriers = 94% AV Silver Claims Cost - 87% AV Silver Claims Cost
a. The 94% AV Silver Claims Cost will be determined by the calculation in subsection 6(B)(3).b. The 87% AV Silver Claims Cost will be determined by the calculation in subsection 6(B)(2).c. In cases where an enrollee is not enrolled for the full month, payments will be calculated on a pro rata basis.5. The Division will apply this method consistently across carriers using values supplied in rate filings, particularly URRTs, PBTs, and Rate Table Templates. a. This method provides an actuarially sound estimate of the claims cost by carrier, plan, and age for a given person insured in the Colorado individual market.b. This method will also allow for a determination of total cost after the completion of the previous benefit year given the actual population distribution and total member months during the benefit year.37 CR 11, June 10, 2014, effective 7/1/201437 CR 12, June 25, 2014, effective 7/15/2014Colorado Register, Vol 37, No. 14. July 25, 2014, effective 8/15/201437 CR 23, December 10, 2014, effective 1/1/201538 CR 03, February 10, 2015, effective 3/15/201538 CR 06, March 25, 2015, effective 4/30/201538 CR 09, May 10, 2015, effective 6/1/201538 CR 13, July 10, 2015, effective 7/30/201538 CR 19, October 10, 2015, effective 11/1/201538 CR 21, November 10, 2015, effective 1/1/201638 CR 23, December 10, 2015, effective 1/1/201639 CR 01, January 10, 2016, effective 2/1/201639 CR 05, March 10, 2016, effective 4/1/201639 CR 08, April 25, 2016, effective 5/15/201639 CR 19, October 10, 2016, effective 11/1/201639 CR 20, October 25, 2016, effective 1/1/201739 CR 22, November 25, 2016, effective 1/1/201739 CR 23, December 10, 2016, effective 1/1/201739 CR 23, December 25, 2016, effective 1/1/201740 CR 03, February 10, 2017, effective 3/15/201740 CR 09, May 10, 2017, effective 6/1/201740 CR 15, August 10, 2017, effective 9/1/201740 CR 17, September 10, 2017, effective 10/1/201740 CR 21, November 10, 2017, effective 12/1/201741 CR 04, February 25, 2018, effective 4/1/201841 CR 05, March 10, 2018, effective 6/1/201841 CR 08, April 25, 2018, effective 6/1/201841 CR 09, May 10, 2018, effective 6/1/201841 CR 11, June 10, 2018, effective 7/1/201841 CR 15, August 10, 2018, effective 9/1/201841 CR 17, September 10, 2018, effective 10/1/201841 CR 18, September 25, 2018, effective 10/15/201841 CR 21, November 10, 2018, effective 12/1/201841 CR 23, December 10, 2018, effective 1/1/201942 CR 01, January 10, 2019, effective 2/1/201941 CR 19, October 10, 2018, effective 3/1/201942 CR 03, February 10, 2019, effective 4/1/201942 CR 04, February 25, 2019, effective 4/1/201942 CR 06, March 25, 2019, effective 6/1/201942 CR 08, April 10, 2019, effective 6/1/201942 CR 15, August 10, 2019, effective 9/1/201942 CR 17, September 10, 2019, effective 10/1/201943 CR 02, January 25, 2020, effective 12/20/201943 CR 02, January 25, 2020, effective 12/23/201942 CR 23, December 10, 2019, effective 1/1/202043 CR 01, January 10, 2020, effective 2/1/202042 CR 24, December 25, 2019, effective 2/2/202043 CR 06, March 25, 2020, effective 4/15/202043 CR 10, May 25, 2020, effective 8/1/202043 CR 14, July 25, 2020, effective 8/15/202043 CR 17, September 10, 2020, effective 10/1/202043 CR 18, September 25, 2020, effective 11/1/202043 CR 22, November 25, 2020, effective 12/15/202043 CR 24, December 25, 2020, effective 1/15/202144 CR 03, February 10, 2021, effective 3/15/202144 CR 08, April 25, 2021, effective 5/15/202144 CR 09, May 10, 2021, effective 6/1/202144 CR 10, May 25, 2021, effective 6/14/202144 CR 10, May 25, 2021, effective 6/15/202144 CR 13, July 10, 2021, effective 8/1/202144 CR 15, August 10, 2021, effective 9/1/202144 CR 19, October 10, 2021, effective 11/1/202144 CR 21, November 10, 2021, effective 12/1/202144 CR 23, December 10, 2021, effective 12/30/202144 CR 21, November 10, 2021, effective 1/1/202244 CR 23, December 10, 2021, effective 1/15/202244 CR 24, December 25, 2021, effective 1/15/202245 CR 03, February 10, 2022, effective 3/2/202245 CR 08, April 25, 2022, effective 5/30/202245 CR 09, May 10, 2022, effective 5/30/202245 CR 10, May 25, 2022, effective 6/14/202245 CR 11, June 10, 2022, effective 6/30/202245 CR 11, June 10, 2022, effective 7/15/202245 CR 19, October 10, 2022, effective 11/1/202245 CR 20, October 25, 2022, effective 11/14/202245 CR 21, November 10, 2022, effective 11/30/202245 CR 24, December 25, 2022, effective 1/14/202346 CR 01, January 10, 2023, effective 2/14/202346 CR 06, March 25, 2023, effective 2/15/202346 CR 03, February 10, 2022, effective 3/2/202346 CR 04, February 25, 2023, effective 3/17/202346 CR 05, March 10, 2023, effective 4/15/202346 CR 09, May 10, 2023, effective 5/30/202346 CR 09, May 10, 2023, effective 6/1/202346 CR 10, May 25, 2023, effective 6/15/202346 CR 11, June 10, 2023, effective 6/30/202346 CR 16, August 25, 2023, effective 9/14/202347 CR 19, October 10, 2024, effective 10/30/2024