Section 0780-01-93-.08 - REASONABLENESS OF BENEFITS IN RELATION TO PREMIUM(1) New Forms and Rate Revisions(a) New forms and filings of new premium rates on a previously approved policy, endorsement rider, or certificate benefits will be presumed to be reasonable in relation to premiums provided the anticipated medical loss ratio is at least 80% in the individual and small group markets for all health insurance; however, failure to meet the anticipated medical loss ratio alone will not constitute an unreasonable rate.(b) The medical loss ratio shall be calculated pursuant to the standards set forth by the U.S. Department of Health and Human Services interim final regulation at 45 C.F.R. part 158 or the corresponding section of any future HHS regulation. For the purposes of this Rule, "small group market" shall mean products sold to employers who employed an average of at least 1 but not more than 100 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.(2) Companies are urged to review their experience periodically and to file rate revisions, as appropriate, in a timely manner to avoid the necessity of later filing of exceptionally large rate increases.Tenn. Comp. R. & Regs. 0780-01-93-.08
Emergency rule filed August 29, 2011; effective through February 25, 2012. Original rule filed November 22, 2011; effective February 20, 2012.Authority: T.C.A. §§ 4-5-206, 56-1-212, 56-2-201, 56-2-301, 56-7-2802, 56-26-102, 56-26-103, 56-26114, 56-26-202, 56-27-112, 56-28-106, 56-29-117, 56-32-107, Public Law 111-148 as amended by Public Law 111-152 (2010), and 45 C.F.R. part 158.