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Pennsylvania Statutes Title 40 P.S. Insurance § 981-7. Excessive loss provision

Current as of January 01, 2022 | Updated by FindLaw Staff

(a) At any time, the designated insurer may file for a rate adjustment for products offered under section 1005-A with the commissioner in accordance with the act of December 18, 1996 (P.L. 1066, No. 159),  1 known as the “Accident and Health Filing Reform Act.”

(b) The designated insurer may request that the commissioner conduct a hearing if:

(1) the losses experienced by the designated insurer on products offered under section 1005-A(a)(1)  2 or by eligible individuals under section 1005-A(a)(2) require a rate increase of greater than twenty per centum (20%) and the losses are in excess of a one hundred ten per centum (110%) medical loss ratio for any calendar year; or

(2) the designated insurer requested a rate increase for products under section 1005-A(a) and has reason to believe that continuation as a designated insurer will have a detrimental impact on its financial condition or solvency.

(c) Upon the request of a designated insurer under subsection (b), the commissioner shall conduct a public hearing regarding the rate filing, medical loss ratio or the impact that being a designated insurer is having on the designated insurer's solvency. The hearing shall be held as provided for in 2 Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of Commonwealth agencies). Following the hearing, the commissioner shall determine the extent of the impact, if any, of being a designated insurer under this article on the designated insurer's rate filing, medical loss ratio, overall operations and solvency, and shall do one or more of the following:

(1) grant, modify or deny the requested rate filing; or

(2) request to withdraw from the approved alternative mechanism and to authorize implementation of the Federal default standards set forth in section 2741 of the Federal act.

1 40 P.S. § 3801.101 et seq.
2 40 P.S. § 981-5(a)(1).
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Cite this article: FindLaw.com - Pennsylvania Statutes Title 40 P.S. Insurance § 981-7. Excessive loss provision - last updated January 01, 2022 | https://codes.findlaw.com/pa/title-40-ps-insurance/pa-st-sect-40-981-7/

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