Amount of change in rate of single block of business; plan with provision for restricted network; involuntary transfer of individual or dependent prohibited; premiums adjusted for block of business.
1. The amount of change in the rate of a single block of business of an individual carrier in any 12-month period because of claims experience or health status-related factors of that block of business, after adjustment for allowed rating characteristics and design of benefits, must not exceed the amount of any similar change in the rate of any other block of business of that individual carrier during the same period by more than 15 percent.
2. For the purposes of NRS 689A.470 to 689A.740, inclusive, a health benefit plan that contains a provision for a restricted network must not be considered to be a similar design of benefits when compared to a health benefit plan that does not contain such a provision if the restriction of benefits to the network providers results in substantial differences in the cost of claims.
3. An individual carrier shall not transfer an individual or his dependent covered by an individual health benefit plan issued by the individual carrier involuntarily into or out of a block of business.
4. If an individual carrier adjusts its premiums for a block of business to a level that is higher than permitted by requirements relating to the ratio of losses, as set forth in this Title and the regulations adopted pursuant thereto, to comply with this section and NRS 689A.680, the individual carrier shall make such adjustments on its entire individual health benefit plan business as needed to meet those requirements.
Last modified: February 27, 2006