§ 58-54-20. Loss ratio standards and filing requirements. - North Carolina Statutes

§58‑54‑20.  Loss ratio standards and filing requirements.

(a)        Every insurerproviding group Medicare supplement insurance benefits to a resident of thisState pursuant to G.S. 58‑54‑5 shall file a copy of the masterpolicy and any certificate used in this State in accordance with the filingrequirements and procedures applicable to group policies issued in this State.

(b)        Policies shallreturn to policyholders benefits that are reasonable in relation to the premiumcharged. The Commissioner shall adopt rules to establish minimum standards forloss ratios of policies on the basis of incurred claims experience, or incurredhealth care expenses where coverage is provided by a health maintenanceorganization on a service rather than reimbursement basis, and earned premiumsin accordance with accepted actuarial principles and practices. Every insurerproviding policies or certificates in this State shall annually file its rates,rating schedules, and supporting documentation to demonstrate that it is incompliance with the applicable loss ratio standards of this State. All filingsof rates and rating schedules shall demonstrate that the actual and expectedlosses in relation to premiums comply with the requirements of this Article.

(c)        No insurer shallprovide compensation to its agents or other producers that is greater than therenewal compensation that would have been paid on an existing policy if theexisting policy is replaced by another policy with the same insurer where thenew policy benefits are substantially similar to the benefits under the oldpolicy and the old policy was issued by the same insurer or insurer group. (1989,c. 729, s. 1; 1991 (Reg. Sess., 1992), c. 815, s. 4.)