S.F. 20 Section 1. Section 505.19, subsections 1 through 4, Code 1 2011, are amended by striking the subsections and inserting in 2 lieu thereof the following: 3 1. All health insurance carriers licensed to do business 4 in the state shall immediately notify policyholders and the 5 public of any application for a rate increase that is filed 6 with the insurance division. Such notice shall include all of 7 the following: 8 a. The specific rate increase proposed that is applicable to 9 each policyholder. 10 b. A detailed justification, in plain language and 11 including a summary, for the rate increase proposed that 12 includes a ranking and quantification of those factors that 13 are responsible for the amount of the rate increase proposed, 14 including data on which medical costs are responsible for 15 any part of the rate increase proposed and the amount of any 16 increase in those medical costs. 17 c. Information on how the policyholder or a member of the 18 public can contact the consumer advocate for assistance or to 19 make a comment on the proposed rate increase. 20 2. The commissioner, by rule, shall adopt a uniform format 21 and uniform documentation requirements for all applications for 22 rate increases filed by health insurance carriers licensed to 23 do business in the state. 24 3. The consumer advocate shall solicit public comments 25 on each proposed rate increase application, and shall post 26 without delay all comments received on the insurance division’s 27 internet site prior to approval or disapproval of the proposed 28 rate increase by the commissioner. 29 4. Prior to approval or disapproval of a proposed rate 30 increase, the commissioner shall hold a public hearing at 31 the time a carrier files an application for a proposed rate 32 increase that exceeds either of the following: 33 a. The average annual health spending growth rate stated 34 in the most recent national health expenditure projection 35 -1- LSB 1158SS (2) 84 av/nh 1/ 3

S.F. 20 published by the centers for Medicare and Medicaid services of 1 the United States department of health and human services. 2 b. Ten percent of the average premium or payment for a given 3 classification of coverage in the individual insurance market. 4 Sec. 2. Section 505.19, Code 2011, is amended by adding the 5 following new subsections: 6 NEW SUBSECTION . 4A. The consumer advocate shall present 7 the public testimony, if any, and public comments received by 8 the consumer advocate, for consideration by the commissioner 9 in determining whether to approve or disapprove an application 10 for a rate increase. 11 NEW SUBSECTION . 4B. In determining whether to approve or 12 disapprove an application for a rate increase, the commissioner 13 shall take into consideration the profits, existing surplus, 14 and rate increase history of the health insurance carrier 15 applying for the rate increase, and the impact of approving the 16 rate increase on policyholders. 17 NEW SUBSECTION . 4C. A health insurance carrier shall 18 provide notice to policyholders and the public of an approved 19 rate increase at least sixty days prior to the date the rate 20 increase goes into effect. 21 EXPLANATION 22 This bill relates to health insurance rate increase 23 applications, including notice requirements, and public comment 24 and hearing requirements. 25 Code section 505.19 is amended to require that health 26 insurance carriers licensed to do business in the state must 27 provide notification of all applications for rate increases 28 filed with the commissioner of insurance to policyholders 29 and to the public. Currently, such notification is required 30 only if the amount of the proposed rate increase exceeds the 31 average annual health spending growth rate stated in the most 32 recent national health expenditure projection published by the 33 centers for Medicare and Medicaid services of the United States 34 department of health and human services. 35 -2- LSB 1158SS (2) 84 av/nh 2/ 3

S.F. 20 The required notice must include specified information 1 including a detailed justification for the rate increase 2 in plain language and how to contact the consumer advocate 3 for assistance or to comment on the proposed increase. The 4 commissioner is required to adopt a uniform format and uniform 5 documentation requirements for all applications for rate 6 increases. 7 The consumer advocate is required to solicit public comments 8 on each proposed rate increase application and post them on the 9 insurance division’s internet site. In addition, the consumer 10 advocate is required to present public testimony, if any, and 11 public comments received, for consideration by the commissioner 12 in determining whether to approve or disapprove an application 13 for a rate increase. 14 If the amount of the proposed rate increase exceeds either 15 the average annual health spending growth rate or 10 percent of 16 the average premium or payment for a given classification of 17 coverage in the individual insurance market, the commissioner 18 is required to hold a public hearing on the rate increase 19 application prior to its approval or disapproval. Currently, 20 the commissioner is required to hold a public hearing only if 21 the proposed rate increase exceeds the average annual health 22 spending growth rate. 23 The commissioner is also required to take into consideration 24 the profits, existing surplus, and rate increase history of 25 each health insurance carrier applying for a rate increase, 26 and the impact of the rate increase on policyholders before 27 approving or disapproving an application for the rate increase. 28 A health insurance carrier must provide notice to policyholders 29 and the public of an approved rate increase at least 60 days 30 prior to the date the rate increase goes into effect. 31 -3- LSB 1158SS (2) 84 av/nh 3/ 3