Ch. 258

1994 LAWS OF MARYLAND

REPORT IN A FORM REQUIRED BY THE COMMISSIONER THAT INCLUDES, FOR THE
PRECEDING CALENDAR YEAR, THE FOLLOWING DATA IN THE AGGREGATE FOR ALL
HEALTH BENEFIT PLANS SPECIFIC TO THIS STATE:

(I)       PREMIUMS WRITTEN;

(II)     PREMIUMS EARNED;

(III)    TOTAL AMOUNT OF INCURRED CLAIMS INCLUDING RESERVES
FOR CLAIMS INCURRED BUT NOT REPORTED AT THE END OF THE PREVIOUS YEAR;

(IV)    TOTAL AMOUNT OF INCURRED EXPENSES, INCLUDING
COMMISSIONS, ACQUISITION COSTS, GENERAL EXPENSES, TAXES, LICENSES, AND
FEES, USING ESTIMATES WHEN NECESSARY;                                                

(V)     LOSS RATIO; AND

(VI)    EXPENSE RATIO.                                                 

(2)      (I) IF THE LOSS RATIO OF AN INSURER, OTHER THAN AN INSURER
THAT PROVIDES HEALTH INSURANCE EXCLUSIVELY TO INDIVIDUALS, OR HEALTH
MAINTENANCE ORGANIZATION IS LESS THAN 75 PERCENT OR IF ITS EXPENSE RATIO
IS MORE THAN 20 PERCENT, THE COMMISSIONER MAY REQUIRE THE INSURER OR
HEALTH MAINTENANCE ORGANIZATION TO FILE NEW RATES FOR ITS HEALTH
BENEFIT PLANS.                                                                                     

(II) IF THE LOSS RATIO OF A NONPROFIT HEALTH SERVICE PLAN IS
LESS THAN 75 PERCENT OR IF THE EXPENSE RATIO OF A NONPROFIT HEALTH
SERVICE PLAN IS MORE THAN 18 PERCENT, THE COMMISSIONER MAY REQUIRE THE
NONPROFIT HEALTH SERVICE PLAN TO FILE NEW RATES FOR ITS HEALTH BENEFIT
PLANS.                                                                                                     

(III) THE AUTHORITY OF THE COMMISSIONER TO REQUIRE AN
INSURER TO FILE NEW RATES BASED ON THE INSURER'S LOSS RATIO UNDER THIS
PARAGRAPH SHALL BE DEEMED TO BE IN ADDITION TO ANY OTHER AUTHORITY OF THE
COMMISSIONER UNDER THIS ARTICLE TO REQUIRE THAT RATES NOT BE EXCESSIVE,
INADEQUATE, OR UNFAIRLY DISCRIMINATORY AND MAY NOT BE CONSTRUED TO LIMIT
THE AUTHORITY OF THE COMMISSIONER TO REVIEW THE LOSS RATIOS OF INSURERS TO
DETERMINE WHETHER A RATE IS EXCESSIVE.                                           

(3)      IN DETERMINING WHETHER TO REQUIRE AN INSURER TO FILE NEW
RATES UNDER. PARAGRAPH (2) OF THIS SUBSECTION, THE COMMISSIONER MAY
CONSIDER THE AMOUNT OF HEALTH INSURANCE PREMIUMS EARNED IN THE STATE
ON INDIVIDUAL POLICIES IN PROPORTION TO THE TOTAL HEALTH INSURANCE
PREMIUMS EARNED IN THE STATE FOR THE INSURER. THE INSURER SHALL
PROVIDE TO THE COMMISSIONER THE INFORMATION NECESSARY TO MAKE A
DETERMINATION OF THE PROPORTION OF INDIVIDUAL PREMIUMS TO TOTAL
PREMIUMS AS PROVIDED UNDER THIS PARAGRAPH.

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