Michigan Compiled Laws
218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)
Section 500.3855 - Annual Filing of Rates, Rating Schedule, and Supporting Documentation; Premium Adjustments; Public Hearing for Rate Increase; Failure to Make Premium Adjustments.

Sec. 3855.
(1) Each insurer that issues medicare supplement policies for delivery in this state shall file annually with the commissioner, on a form and in the manner prescribed by the commissioner, its rates, rating schedule, and supporting documentation including all claims experience of the insurer for medicare supplement coverage. The filings and schedules shall demonstrate that the actual and expected losses in relation to premiums are in compliance with the applicable loss ratio standards of this state. The supporting documentation shall also be in accordance with actuarial standards of practice using reasonable assumptions that the appropriate loss ratio standards can be expected to be met over the entire period for which rates are computed excluding active life reserves. An expected third-year loss ratio that is greater than or equal to the applicable percentage under section 3851 shall be demonstrated for policies or certificates in force less than 3 years.
(2) An insurer shall make such premium adjustments as are necessary to produce an expected loss ratio under the medicare supplement policy as will conform with minimum loss ratio standards for medicare supplement policies and certificates and that are expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the insurer for such medicare supplement insurance policies. A premium adjustment that would modify the loss ratio experience under the policy shall not be made with respect to a policy at any time other than upon its renewal date or anniversary date.
(3) The commissioner may conduct a public hearing to gather information concerning a request by a medicare supplement insurer for an increase in a rate for a medicare supplement policy form or certificate form issued before or after the effective date of this chapter if the experience of the form for the previous reporting period is not in compliance with the applicable loss ratio standard. The determination of compliance shall be made without consideration of any refund or credit for the reporting period. Public notice of the hearing shall be furnished in a manner considered appropriate by the commissioner.
(4) If a medicare supplement insurer fails to make premium adjustments acceptable to the commissioner, the commissioner may order premium adjustments, refunds, or premium credits considered necessary to achieve the loss ratio required by this section.
History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218

Structure Michigan Compiled Laws

Michigan Compiled Laws

Chapter 500 - Insurance Code of 1956

Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)

218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)

Section 500.3801 - Chapter; Definitions.

Section 500.3803 - Applicability of Chapter.

Section 500.3804 - Repealed. 2018, Act 429, Eff. Mar. 20, 2019.

Section 500.3805 - Medicare Supplement Policy; Definitions.

Section 500.3807 - Basic Core Package of Benefits; Standards for Plans K and L; Applicability of Section.

Section 500.3807a - Medicare Supplement Policies or Certificates With Effective Date for Coverage on or After June 1, 2010; Basic Core Package of Benefits.

Section 500.3808 - Repealed. 2018, Act 429, Eff. Mar. 20, 2019.

Section 500.3809 - Additional Benefits; Reimbursement for Preventive Screening Tests and Services; Definitions; Applicability of Section.

Section 500.3809a - Medicare Supplement Policies or Certificates With Effective Date for Coverage on or After June 1, 2010; Additional Benefits.

Section 500.3811 - Basic Core Benefits; Availability; Sale of Certain Benefits Prohibited; Designations, Structure, Language, and Format; Other Designations; Requirements; Applicability of Section.

Section 500.3811a - Medicare Supplement Policies or Certificates With Effective Date for Coverage on or After June 1, 2010; Basic Core Benefits; Availability; Sale of Certain Benefits Prohibited; Structure, Language, Designation, and Format; Other De...

Section 500.3811b - Medicare Supplement Policies or Certificates for Newly Eligible Individuals After December 31, 2019; Exceptions to Standards and Requirements.

Section 500.3813 - Disability Coverage; Medicare Supplement Buyer's Guide; Applicability of Section.

Section 500.3815 - Outline of Coverage; Acknowledgment of Receipt; Compliance With Notice Requirements; Substitute; Language, Written or Electronic Format, and Required Items.

Section 500.3817 - Medicare Select Policies and Certificates; Definitions; Requirements for Issuance; Plan of Operation; Filing, Format, and Contents; Proposed Changes; Updated List of Network Providers; Payment for Covered Services Not Available Thr...

Section 500.3819 - Minimum Standards; Suspension of Benefits and Premiums; Notice; Reinstitution; Offer to Exchange 1990 Standardized Plan to 2010 Plan.

Section 500.3819a - Medicare Supplement Policies or Certificates With Effective Date for Coverage on or After June 1, 2010; Minimum Standards.

Section 500.3821 - Issuance of Policy to Person Not Enrolled in Medicare Parts a and B Prohibited; Refund; Interest.

Section 500.3823 - Covered Benefits More Restrictive Than Benefits Under Medicare and Required Under State Law Prohibited; Benefits for Outpatient Prescription Drugs.

Section 500.3825 - Preexisting Diseases or Conditions; Waiver Prohibited.

Section 500.3827 - Duplicate Benefits Prohibited; Application; Statements and Questions Whether Another Policy in Force; List of Policies Sold to Applicant; Notice Regarding Replacement Coverage.

Section 500.3829 - Denying or Conditioning Issuance Based on Health Status, Claims Experience, Receipt of Health Care, or Medical Condition of Applicant Prohibited; Condition; Exclusion of Benefits Based on Preexisting Conditions; Reduction; Creditab...

Section 500.3829a - Medicare Supplement Policies or Certificates Delivered, Issued for Delivery, or Renewed on or After May 21, 2009; Genetic Test; Definitions.

Section 500.3830 - Eligible Person; Requirements.

Section 500.3830a - Termination of Contract or Agreement; Notice to Individual.

Section 500.3831 - Individual or Group Expense Incurred Hospital, Medical, or Surgical Policies; Right of Continuation or Conversion to Medicare Supplemental Plan; Request for Coverage; Exclusion From Preexisting Conditions; Notice of Availability of...

Section 500.3833 - Replacement Policy; Waiver of Certain Time Periods.

Section 500.3835 - Marketing Procedures; Determining Appropriateness of Recommended Purchase or Replacement; More Than 1 Policy Prohibited; Individual Enrolled in Medicare Advantage; "Notice to Buyer" Displayed.

Section 500.3837 - Repealed. 2002, Act 304, Imd. Eff. May 10, 2002.

Section 500.3839 - Renewal or Continuation Provision; Effect of Termination or Replacement; Elimination of Outpatient Prescription Drug Benefit.

Section 500.3841 - Riders or Endorsements; Signed Acceptance or Agreement; Additional Premium; Use of Certain Standards, Terms, and Words; Filing of Changes in Medicare Benefits; Elimination of Duplicate Benefits; Notice of Modifications; Notice Requ...

Section 500.3843 - Health Insurance; Notice; Contents; Applicability of Subsection (1).

Section 500.3847 - Advertising; Filing Copy With Director.

Section 500.3849 - Filing and Approval Requirements; Deletion of Outpatient Prescription Drug Benefits; Issuance of Policy; Use and Change in Premium Rates; Additional Forms; Availability; Conditions and Effect of Discontinuance; Combining Forms for...

Section 500.3851 - Aggregate Benefits; Rates, Rating Schedules, and Rate Revisions.

Section 500.3852 - Benchmark Ratio.

Section 500.3853 - Refund or Credit Calculation; Form; Interest; Due Date.

Section 500.3855 - Annual Filing of Rates, Rating Schedule, and Supporting Documentation; Premium Adjustments; Public Hearing for Rate Increase; Failure to Make Premium Adjustments.

Section 500.3857 - Duties of Insurer; Certification of Compliance With Subsection (1)(a).

Section 500.3859 - Prohibited Conduct; Violation as Misdemeanor; Penalty.

Section 500.3861 - Probable Cause of Violation; Notice of Hearing; Opportunity to Confer and Discuss; Hearing; Applicability of MCL 500.2038 to 500.2040; Violation; Penalty.