Section 26-A3510. FILING REQUIREMENTS FOR RATING INFORMATION

 

3510.1A schedule of enrollment fees or methodology for determining enrollment fees due must be filed and approved by the Commissioner before the fees can be used by the HMO.

 

3510.2Either a specific schedule of fees, or a methodology for determining fees, shall be established in accordance with actuarial principles for various categories of enrollees, provided that the enrollment fees applicable to an enrollee shall not be individually determined based on the status of an enrollee's health.

 

3510.3Enrollment fees shall not be excessive, inadequate or discriminatory.

 

3510.4A statement 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 schedule of fees along with adequate supporting information.

 

3510.5When a schedule of enrollment fees or a method of determining enrollment fees filed by an HMO is disapproved by the Commissioner, written notice specifying the reasons for the disapproval shall be sent to the HMO. A hearing will be held within thirty (30) days after a request in writing for a hearing by the person submitting the fee schedule or methodology. The schedule or methodology is considered approved by the Commissioner if the Commissioner takes no action on the schedule or methodology within thirty (30) days of its filing.

 

source

Final Rulemaking published at 46 DCR 7291(September 17, 1999).