(1) No premium rate may be used until either a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the commissioner.
(2) Either a specific schedule of premium rates, or a methodology for determining premium rates, shall be established in accordance with actuarial principles for various categories of enrollees, provided that the premium applicable to an enrollee shall not be individually determined based on the status of the enrollee’s health. However, the premium rates shall not be excessive, inadequate or unfairly discriminatory. A certification by a qualified actuary or other qualified person acceptable to the commissioner as to the appropriateness of the use of the methodology, based on reasonable assumptions, shall accompany the filing along with adequate supporting information.
(3) The commissioner shall approve the schedule of premium rates or methodology for determining premium rates if the requirements of subsection (2) are met. If the commissioner disapproves the filing, he shall notify the health maintenance organization. In the notice, the commissioner shall specify the reasons for his disapproval. A hearing will be conducted within thirty (30) days after a request in writing by the person filing.
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