MO SB348

Health carriers must file premium rates, risk classifications, and supporting information with the Department of Insurance no later than 60 days before the effective date, beginning July 1, 2013.

Rate filings must include actuarial justification, detailed factors supporting the premium calculations, and certification by a qualified actuary that rates are not excessive, inadequate, or unfairly discriminatory.

The director must review proposed rates and make a determination within 30 days of filing as to whether rates are excessive, inadequate, or unfairly discriminatory based on loss experience, loss ratios, expenses, utilization trends, and contingency reserves.

For significant rate increases, health carriers must notify affected enrollees, the director must hold a public hearing within 30 days, solicit public comments, and issue an order approving or prohibiting the proposed rate within 20 days of the hearing.

Enrollees or policyholders paying all or a majority of premiums may seek judicial review if the increase equals or exceeds 8% for the same coverage or 20% for additional coverage, provided they pay all or a majority of the increase and file only one appeal per policy period.