Rule 120-2-98-.05. Standards of Review

In addition to standards or criteria of review that are otherwise applicable to a rate increase subject to review under this regulation, the following standards will apply to the review of rates to the extent applicable to the filing under review: (1) The impact of medical trend changes by major service categories; (2) The impact of utilization changes by major service categories; (3) The impact of cost-sharing changes by major service categories; (4) The impact of benefit changes; (5) The impact of changes in enrollee risk profile; (6) The impact of any overestimate or underestimate of medical trend for prior year periods related to the rate increase; (7) The impact of changes in reserve needs; (8) The impact of changes in administrative costs related to programs that improve health care quality; (9) The impact of changes in other administrative costs; (10) The impact of changes in applicable taxes, licensing or regulatory fees; (11) Medical loss ratio; and (12) The health insurance issuer's capital and surplus. Cite as Ga. Comp. R. & Regs. R. 120-2-98-.05
Authority: O.C.G.A. Sections 33-2-9, 33-9-1et seq., 33-21-13, 33-21-18(a), 33-21-28.
History. Rule entitled "Standards of Review" adopted. F. Dec. 6, 2011; eff. Dec. 26, 2011.