Current Status Introducing Body:House Bill Number:3325 Primary Sponsor:Boan Committee Number:26 Type of Legislation:GB Subject:Major medical expense coverage policies Residing Body:House Current Committee:Labor, Commerce and Industry Companion Bill Number:519 Computer Document Number:CYY/18060.SD Introduced Date:Jan 24, 1991 Last History Body:House Last History Date:Jan 24, 1991 Last History Type:Introduced, read first time, referred to Committee Scope of Legislation:Statewide All Sponsors:Boan McElveen Type of Legislation:General Bill
Bill Body Date Action Description CMN
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3325 House Jan 24, 1991 Introduced, read first time, 26
referred to Committee
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TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-325 SO AS TO PROVIDE FOR ADDITIONAL REQUIREMENTS FOR THE APPROVAL OF INDIVIDUAL MAJOR MEDICAL EXPENSE COVERAGE POLICIES.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. The 1976 Code is amended by adding:
"Section 38-71-325. On the effective date of this section, in addition to any other requirements of law, no new individual major medical expense coverage policy, as defined in regulations promulgated by the Commissioner, may be approved unless:
(1) Premium rates, after appropriate allowance for the actuarial value of the difference in benefits, for any such policy form first issued and used by the insurer in South Carolina within the two-year period immediately prior to the effective date of this section and any such policy form first issued after the effective date of this section do not exceed the premium rates for any other such policy form first issued during this period by more than thirty percent;
(2) The actuarial value of the difference in benefits set out in such policy forms of the insurer, as specified in an opinion by a qualified actuary or other qualified person acceptable to the Commissioner, is reported not less often than once a year to the Commissioner and used in demonstrating compliance with item (1) above; and
(3) The insurer files a loss ratio guarantee in accordance with the procedures specified in Section 38-71-310(E) with those changes as may be necessary. The loss ratio for the combined experience for all such policy forms specified in item (1) must be equivalent to or greater than the most recent loss ratios detailed within the National Association of Insurance Commissioner's `Guidelines for Filing of Rates for Individual Health Insurance Forms' or successor publications. The anticipated (target) loss ratio for the combined experience is defined as the average anticipated (target) loss ratio for all such policy forms included in the combined experience weighted by premium volume.
The initial policy form proposed to be used by a domestic insurer after its organization under the laws of this State and the initial policy form proposed to be used by a foreign insurer after authorization by the Commissioner to do business in this State may be disapproved by the Commissioner if he determines that the rates proposed to be used with the policy form are set at a level substantially less than rates charged by other insurers in this State offering comparable coverage.
Nothing contained in this section may be construed to prevent the use of age, sex, area, industry, occupational, and avocational factors or to prevent the use of different rates for smokers and nonsmokers or for any other habit or habits of an insured person which have a statistically proven effect on the health of the person and are approved by the Commissioner. Also, nothing contained in this section shall preclude the establishment of a substandard classification based upon the health condition of the insured, but the initial classification may not be changed adversely to the applicant after initial issue.
The Commissioner has the right, upon application by any insurer, to grant relief, for good cause shown, from any requirement of this section."
SECTION 2. This act takes effect upon approval by the Governor.