11 NCAC 12 .0563             WEIGHTED AVERAGE:  MENTAL ILLNESS BENEFITS COVERAGE

(a)  The definitions contained in G.S. 58-3-220(h) are incorporated into this rule by reference.

(b)  To exercise the option under G.S. 58-3-220(f), at the time of submission for approval of a group health benefit plan policy form, certificate, or rider containing mental illness benefits, the insurer shall include in the submission a certification of compliance with this rule signed by a qualified actuary, as defined in 11 NCAC 16 .0401(17).  The certification of compliance shall include a statement that:

(1)           No more than 70 percent of the entire plan's actuarial value is contained in the selected physical illness and injury benefits that are subject to any limit.

(2)           The weighted average calculation was performed and calculated as prescribed in paragraph (c) of this rule.

(c)  The weighted average calculation shall be performed on a benefit-by-benefit basis. The weighted average for a limit shall be calculated by summing the product of the expected value of each physical illness and injury benefit and its applicable limit, and then dividing that summation by the sum of the expected values of each physical illness and injury benefit.

(d)  An insurer shall make the information, documentation, and actuarial calculations described in this rule available to the Commissioner upon request.

 

History Note:        Authority G.S. 58-2-40; 58-3-220;

Eff. July 1, 2008.