58-50-131. Premium rates for health benefit plans; approval authority; hearing.
(a) No schedule of premium rates for coverage for a health benefit plan subject to this act, or any amendment to the schedule, shall be used in conjunction with any such health benefit plan until a copy of the schedule of premium rates or premium rate amendment has been filed with and approved by the Commissioner. Any schedule of premium rates or premium rate amendment filed under this section shall be established in accordance with G.S. 58-50-130(b). The schedule of premium rates shall not be excessive, unjustified, inadequate, or unfairly discriminatory and shall exhibit a reasonable relationship to the benefits provided by the contract of insurance. Each filing shall include a certification by an actuary who is a member of the American Academy of Actuaries and qualified to provide such certifications as described in the U.S. Qualifications Standards promulgated by the American Academy of Actuaries pursuant to its Code of Professional Conduct.
(b) The Commissioner shall approve or disapprove a schedule of premium rates within 60 days of receipt of a complete filing. It shall be unlawful to use a schedule of premium rates until approved. If the Commissioner disapproves the filing, the Commissioner shall notify the filer, shall specify the reasons for disapproval, and shall provide an opportunity for refiling.
(c) The Commissioner shall adopt rules as necessary or proper (i) to prevent the federal preemption of health insurance regulation in the State, (ii) to implement the provisions of this section, and (iii) to establish minimum standards for loss ratios of policies subject to this section in accordance with accepted actuarial principles and practices to assure that the benefits are reasonable in relation to the premium charged. The Commissioner shall adopt rules to require the submission of supporting data and any information that the Commissioner considers necessary or proper to determine whether the filed schedule of premium rates meets the standards set forth in this section. (2011-196, s. 4; 2013-199, s. 9.)
Structure North Carolina General Statutes
North Carolina General Statutes
Article 50 - General Accident and Health Insurance Regulations.
§ 58-50-1 - Waiver by insurer.
§ 58-50-15 - Conforming to statute.
§ 58-50-25 - Nurses' services.
§ 58-50-26 - Physician services provided by physician assistants.
§ 58-50-30 - Right to choose services of certain providers.
§ 58-50-35 - Notice of nonpayment of premium required before forfeiture.
§ 58-50-45 - Group health or life insurers to notify insurance fiduciaries of obligations.
§ 58-50-46 - Recodified as G.S108A-55.4 by Session Laws 2006-221, s9(a), effective January 1, 2007.
§ 58-50-56 - Insurers, preferred provider organizations, and preferred provider benefit plans.
§ 58-50-56.1 - Exclusive provider organizations, exclusive provider benefit plans.
§ 58-50-56.2 - Exclusive provider organization continuity of care.
§ 58-50-57 - Offsets against provider reimbursement for workers' compensation payments forbidden.
§ 58-50-61 - Utilization review.
§ 58-50-62 - Insurer grievance procedures.
§ 58-50-63 - Expired pursuant to Session Laws 2005-453, s3, effective July 1, 2005.
§ 58-50-65 - Certain policies of insurance not affected.
§ 58-50-70 - Punishment for violation.
§ 58-50-75 - Purpose, scope, and definitions.
§ 58-50-77 - Notice of right to external review.
§ 58-50-79 - Exhaustion of internal grievance process.
§ 58-50-80 - Standard external review.
§ 58-50-82 - Expedited external review.
§ 58-50-84 - Binding nature of external review decision.
§ 58-50-85 - Approval of independent review organizations.
§ 58-50-87 - Minimum qualifications for independent review organizations.
§ 58-50-89 - Hold harmless for Commissioner and independent review organizations.
§ 58-50-90 - External review reporting requirements.
§ 58-50-92 - Funding of external review.
§ 58-50-93 - Disclosure requirements.
§ 58-50-94 - Selection of independent review organizations.
§ 58-50-100 - Title and reference.
§ 58-50-105 - Purpose and intent.
§ 58-50-112 - Affiliated companies; HMOs.
§ 58-50-115 - Health benefit plans subject to Act.
§ 58-50-125 - Health care plans; formation; approval; offerings.
§ 58-50-130 - Required health care plan provisions.
§ 58-50-131 - Premium rates for health benefit plans; approval authority; hearing.
§ 58-50-149 - Limit on cessions to the Reinsurance Pool.
§ 58-50-150 - North Carolina Small Employer Health Reinsurance Pool.
§ 58-50-275 - Notice contact provisions.
§ 58-50-280 - Contract amendments.
§ 58-50-285 - Policies and procedures.
§ 58-50-292 - Dental provider networks; confidential business information.
§ 58-50-295 - Prohibited contract provisions related to reimbursement rates.