California Rate Filing Form (final, v. 2)
A PDF version of this form is available. Insurance companies should use the PDF version in submitting rate filings.
California Rate Filing Form
For Individual and Small Group Health Insurance Rate Filings for Existing Products, Version 2
(do not use this form for initial filings for new product rates)
The PDF version of the form should be used for rate submissions.
The rate filing submission should include:
- This form.
- A California Rate Filing Spreadsheet.
- An actuarial certification.
- A spreadsheet with rate information responsive to Questions 10 & 15, below.
- A California Plain-Language Filing Form.
- A California Plain-Language Spreadsheet.
The following is the text of the form.
1) Company Name.
2) Number of policy forms covered by the filing.
3) Policy form numbers covered by the filing:List all of the policy form numbers covered by this filing in column "A" of the "California Rate Filing Spreadsheet". List all product names associated with each policy form number in column "B."
4) Product types covered by the filing. Selected from the following: HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), EPO (Exclusive Provider Organization), POS (Point of Service), FFS (Fee for Service), Other (describe).
5) Segment type. One of the following: Small Group (2-50 employees), IndividualNote: Large Group, Small Group, and Individual filings should not be combined within a single filing.
6) Plan/Insurer Type. One of the following: for-profit company, not-for-profit company.
7) Whether the products are open or closed. List each open or closed product by policy form number.For each policy form number, indicate in column "C" of the California Rate Filing Spreadsheet whether the products are open or closed.
8) Enrollment: In column "D" of the California Rate Filing Spreadsheet, state the number of lives, including dependents, covered by each product as of the end of the latest month for which the data has been compiled.
9) Insured months in each policy formIn column "E" of the California Rate Filing Spreadsheet, state the number of insured (or member) months for the experience period on which the rates were based. (Does not apply to rates for new products.)
10) Annual RateIn a separate spreadsheet, for each product included in the filing, show the current and proposed annual premium rates for each rating cell.
11) Total earned premiumFor each policy form list:In column "F" of the California Rate Filing Spreadsheet, state the experience period on which rates are based,In column "G" of the California Rate Filing Spreadsheet, state the period for which rates are to be effective,In column "H" of the California Rate Filing Spreadsheet, state the total premium earned for the experience period on which the rates are based.
12) In column "I" of the California Rate Filing Spreadsheet, state the total dollar amount of incurred claims in each policy form for the experience period on which the rates are based. If helpful to understanding the basis for the filed rate increases, the insurer may, but is not required to, disaggregate incurred claim data into the aggregate benefit categories listed in item 18 below.
13) In column "J" of the CA Rate Filing Spreadsheet, state the average rate increase initially requested. The weighted average of the proposed rate increases included in the filing, weighting the increases by the number of covered lives for each product (per item 8, above). Rates for new products are not included in this calculation, as they have a weight of zero. (Does not apply to rates for new products.)
14) Review category: One of the following: Initial Filing for New Product, Filing for Existing Product, ResubmissionResubmissions should be submitted through SERFF under the same state filing number and SERFF tracking number assigned to the original submission of this filing. Do not submit resubmissions as a new filing.
15) Average rate of increase. In those instances in which there is a revision to the rates requested after initial submission, the revision should be submitted as an amendment to the original submission of this filing under the rate/rule form tab. Submit a revised California Rate Filing Form, a revised spreadsheet responsive to Question 10, and a revised California Rate Filing Spreadsheet, completing columns A, B, and J. Also, in the case of a resubmission, update the information under the "company rate information" field under the "Rate/Rule Schedule" tab in SERFF. The average rate of increase is a weighted average, calculated as in item 13, above.
16) Effective date of rate increase: The earliest anticipated date that the proposed rate increase, or new product rate, will take effect for a policyholder.
17) Number of policyholders or insureds affected by each policy form. This information was provided in item 8, above, and need not be repeated.
18) Overall medical trend factor and trend factors by aggregate benefit category:
Overall Medical Trend Factor
"Overall" means the weighted average of trend factors used to determine rate increases included in the filing, weighting the factor for each aggregate benefit category by the amount of projected medical costs attributable to that category.
Medical Trend Factor by Aggregate Benefit Category
The aggregate benefit categories are each of the following - hospital inpatient, hospital outpatient (including emergency room), physician and other professional services, prescription drugs from pharmacies, laboratory services (other than hospital inpatient), radiology services (other than hospital inpatient), other (describe).
Optional Medical Trend Factor by Aggregate Benefit Category by Geographic Region
The insurer may, but is not required to, aggregate additional data in major geographic regions of the state. If the insurer chooses to so aggregate, the major geographic regions of the state are: Northern California (consisting of Monterey, Kings, Tulare, and Inyo counties, and all counties to the north), and Southern California (consisting of San Luis Obispo, Kern, and San Bernardino counties, and all counties to the south).
19) Projected medical trend. Use the same aggregate benefit categories used in item 18 -hospital inpatient, hospital outpatient (including emergency room), physician and other professional services, prescription drugs from pharmacies, laboratory services (other than hospital inpatient), radiology services (other than Hospital inpatient), other (describe). Furthermore, within each aggregate category quantify the sources of trend, i.e. use of services, price inflation, and fees and risk.
Projected Medical Trend by Aggregate Benefit Category, allocating within each aggregate benefit category between Trend attributable to use of services, trend attributable to price inflation, and trend attributable to fees and risk
20) Comparison of claims cost and rate of changes over time. For each proposed rate increase, provide the projected annualized incurred claims cost per insured for the period covered by the proposed rate, the historical incurred claims cost per insured for the most recent 12 months of the experience period on which the rates were based, and the historical incurred claims cost per insured for the next two most recent 12 month periods. Also, compare the rate of change of claims costs over all of the projected and historical periods for which information is provided. Show all claim costs according to aggregate benefit category.
21) Describe any changes in enrollee/insured cost-sharing, compared to the prior year, associated with the submitted rate filing, including both the absolute amount of the change, and the percentage change, and quantify the impact of each change on each of the rates included in the filing. Also describe any changes in benefits exempted from cost-sharing, as well as any newly-imposed cost-sharing.
22) Describe any changes in enrollee/insured benefits, including but not limited to hospital inpatient, hospital outpatient (including emergency services), physician and other professional services, laboratory services, radiology services, and other benefits (describe), compared to the prior year, associated with the submitted rate filing, and quantify the impact of each change on each of the rates included in the filing.
23) Submit the required actuarial certification, described in Guidance 1163:2, under the "Supporting Documentation" tab in SERFF.
24) Changes in administrative costs. Administrative costs are the costs defined in Sections 158.150, 158.151, 158.160, and 158.161 of 45 Code of Federal Regulations Subtitle A, Subchapter B, in the interim final rule issued by the Department of Health and Human Services on December 1, 2010 at 75 Federal Register 74924-74926. Using those definitions, describe the administrative costs for the policy forms included in this filing for the year prior to the requested rate increase, then also describe any changes in administrative costs, compared to the prior year, associated with the submitted rate filing, and quantify the impact of each change on each of the rates included in the filing. Changes should be shown separately for the costs defined by each of the sections of Code of Federal Regulations listed above in this item. (Does not apply to rates for new products.)
26) Comments. Place any needed comments here.
End of text of form.