1. (1) A carrier that expects to be eligible to receive a defrayal payment shall modify a federal rate filing template as follows:

   1. (a) exclude the expected defrayal payment from the rates submitted on both the Unified Rate Review Template and the Rate Data Template;

   2. (b) indicate in the rate filing's actuarial memorandum:

      1. (i) whether the carrier anticipates a defrayal payment from the state for the cost of an eligible state-required benefit;
      2. (ii) that the cost of the state-required benefit is not included in the premiums; and
      3. (iii) the defrayal payment amount the carrier expects to receive; and
   3. (c) indicate in the "Benefits Information" field on the Plans and Benefits Template that the carrier covers the state-required benefits, selecting the state-required benefit of "Not EHB" for the "EHB Variance Reason" field.

2. (2)(a) A carrier may not factor a state-required benefit into the calculation for the "EHB Percent of Total Premium" field on the Plans and Benefits Template.

   1. (b) A state-required benefit may not be included in the total premium from which the "EHB Percent of Total Premium" field is calculated.

KEY: insurance

Date of Last Change: June 9, 2023

Notice of Continuation: December 16, 2024

Authorizing, and Implemented or Interpreted Law: 31A-30-118(4)