Missouri Revised Statutes
Chapter 383
Malpractice Insurance
←383.203
Section 383.206.1
383.209→
August 28, 2015
Sale of health care provider policy prohibited, when--determining factors--insurer may charge additional premium or grant discount, when--supporting data--rulemaking authority.
383.206. 1. Notwithstanding the provisions of sections 383.037 and
383.160, no insurer shall issue or sell in the state of Missouri a policy
insuring a health care provider, as defined in section 538.205, for damages
for personal injury or death arising out of the rendering of or failure to
render health care services if the director finds, based upon competent and
compelling evidence, that the base rates of such insurer are excessive,
inadequate, or unfairly discriminatory. A rate may be used by an insurer
immediately after it has been filed with the director, until or unless the
director has determined under this section that a rate is excessive,
inadequate, or unfairly discriminatory.
2. In making a determination under subsection 1 of this section, the
director of the department of insurance, financial institutions and
professional registration may use the following factors:
(1) Rates shall not be excessive or inadequate, nor shall they be
unfairly discriminatory;
(2) No rate shall be held to be excessive unless such rate is
unreasonably high for the insurance proved with respect to the classification
to which such rate is applicable;
(3) No rate shall be held to be inadequate unless such rate is
unreasonably low for the insurance provided with respect to the
classification to which such rate is applicable;
(4) To the extent Missouri loss experience is available, rates and
projected losses shall be based on Missouri loss experience and not the
insurance company's or the insurance industry's loss experiences in states
other than Missouri unless the failure to do so jeopardizes the financial
stability of the insurer; provided however, that loss experiences relating to
the specific proposed insured occurring outside the state of Missouri may be
considered in allowing a surcharge to such insured's premium rate;
(5) Investment income or investment losses of the insurance company for
the ten-year period prior to the request for rate approval may be considered
in reviewing rates. Investment income or investment losses for a period of
less than ten years shall not be considered in reviewing rates. Industrywide
investment income or investment losses for the ten-year period prior to the
request for rate approval may be considered for any insurance company that
has not been authorized to issue insurance for more than ten years;
(6) The locale in which the health care practice is occurring;
(7) Inflation;
(8) Reasonable administrative costs of the insurer;
(9) Reasonable costs of defense of claims against Missouri health care
providers;
(10) A reasonable rate of return on investment for the owners or
shareholders of the insurer when compared to other similar investments at the
time of the rate request; except that, such factor shall not be used to
offset losses in other states or in activities of the insurer other than the
sale of policies of insurance to Missouri health care providers; and
(11) Any other reasonable factors may be considered in the disapproval of
the rate request.
3. The director's determination under subsection 1 of this section of
whether a base rate is excessive, inadequate, or unfairly discriminatory may
be based on any subcategory or subspecialty of the health care industry that
the director determines to be reasonable.
4. If actuarially supported and included in a filed rate, rating plan,
rule, manual, or rating system, an insurer may charge an additional premium
or grant a discount rate to any health care provider based on criteria as it
relates to a specified insured health care provider or other specific health
care providers within the specific insured's employ or business entity. Such
criteria may include:
(1) Loss experiences;
(2) Training and experience;
(3) Number of employees of the insured entity;
(4) Availability of equipment, capital, or hospital privileges;
(5) Loss prevention measures taken by the insured;
(6) The number and extent of claims not resulting in losses;
(7) The specialty or subspecialty of the health care provider;
(8) Access to equipment and hospital privileges; and
(9) Any other reasonable criteria identified by the insurer and filed
with the department of insurance, financial institutions and professional
registration.
5. Supporting actuarial data shall be filed in support of a rate, rating
plan, or rating system filing, when requested by the director to determine
whether rates should be disapproved as excessive, inadequate, or unfairly
discriminatory, whether or not the insurer has begun using the rate.
6. The director of the department of insurance, financial institutions
and professional registration shall promulgate rules for the administration
and enforcement of this section. Any rule or portion of a rule, as that term
is defined in section 536.010, that is created under the authority delegated
in this section shall become effective only if it complies with and is
subject to all of the provisions of chapter 536 and, if applicable, section
536.028. This section and chapter 536 are nonseverable and if any of the
powers vested with the general assembly pursuant to chapter 536 to review, to
delay the effective date, or to disapprove and annul a rule are subsequently
held unconstitutional, then the grant of rulemaking authority and any rule
proposed or adopted after August 28, 2006, shall be invalid and void.
(L. 2006 H.B. 1837 § 383.198)
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