Delaware Health Insurance Rate Filing Requirements — Part II Preliminary Justification
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Requirements and the issuer's Part II Preliminary Justification for proposed 2026 individual market rate changes submitted to the Delaware Department of Insurance; affects issuers offering plans in Delaware's individual single risk pool and their impacted members.
No material clinical or coverage changes in this revision.
Issuer Justification and Rate Change Drivers
Issuer-submitted justification elements
Key reported items and analytic justifications the issuer provided for the proposed rate change:
ALL of the following
- Proposed average rate change = 31.8% (increase).
Must match HIOS, Actuarial Memorandum and Company Rate Information Page in SERFF.
- Individual members affected = 10,619.
ALL of the following
- Rate change varies by product and plan, ranging from 29.3% to 41.9%.
- Detailed per-plan cumulative rate changes and Plan IDs are included (no new or non‑renewing plans).
See per-plan list with Plan IDs and cumulative rate change percentages.
ALL of the following
- Experience & Morbidity: updated single risk pool experience and projected utilization trend affecting average morbidity.
- Unit Cost Trend: updates to unit costs and provider reimbursement agreements for the rating year.
- Utilization: projected utilization trends consistent with historical trends and Milliman Health Cost Guidelines.
- Non‑Benefit Expenses: changes in general administrative expenses incorporated into 2026 rates (increased by 1.9%).
- eAPTC expiration impact: expected to increase the index rate by 21.8% between base and projection periods, affecting statewide average morbidity.
ALL of the following
- 1332 reinsurance parameters: attachment point $55,000; cap $340,000; 35% coinsurance.
ALL of the following
- Projected MLR = 85.1% (based on the prescribed 45 CFR 158 calculation applied to the projection year single risk pool experience).
- The projected MLR includes the proposed 31.8% rate increase for 2026.
ALL of the following
- Rate effective period: January 1, 2026 to December 31, 2026.
- Company actions to improve quality and affordability: My Health Pays member incentives; provider incentives tied to quality metrics; deliberate network, product, and marketing actions to serve target populations and keep premiums affordable.
ALL of the following
- There are no new or non‑renewing plans for 2026.
- Rate variation across plans is explained by differences in actuarial value, benefit richness, provider reimbursement assumptions, and induced utilization reflected in per‑plan changes.
ALL of the following
- Issuer provided a summary of historical revenue, claims, expenses, and profit and how the rate change should affect these metrics going forward.
Plan Identifiers, Cumulative Rate Changes, and 1332 Reinsurance Details
| 64004DE0090011 | Clear Gold — Cumulative Rate Change % (over 12 mos prior) = 37.6% |
| 64004DE0090009 | Complete Gold — Cumulative Rate Change % (over 12 mos prior) = 41.9% |
| 64004DE0090013 | Elite Silver — Cumulative Rate Change % (over 12 mos prior) = 35.2% |
| 64004DE0090002 | Everyday Bronze — Cumulative Rate Change % (over 12 mos prior) = 34.8% |
| 64004DE0090007 | Focused Silver — Cumulative Rate Change % (over 12 mos prior) = 29.6% |
| 64004DE0090001 | Principal Bronze HSA — Cumulative Rate Change % (over 12 mos prior) = 41.3% |
| 64004DE0090004 | Standard Expanded Bronze — Cumulative Rate Change % (over 12 mos prior) = 36.2% |
| 64004DE0090012 | Standard Gold — Cumulative Rate Change % (over 12 mos prior) = 39.5% |
| 64004DE0090008 | Standard Silver — Cumulative Rate Change % (over 12 mos prior) = 29.3% |
| 64004DE0100011 | Clear Gold + Vision + Adult Dental — Cumulative Rate Change % (over 12 mos prior) = 37.4% |
Submission Requirements and Actions for Issuers
Submit Part II Preliminary Justification with DOI‑specified content and format
Issuers must submit a Part II Preliminary Justification for all Rate Filings for products offered in the individual and small group single risk pool (positive, negative, or neutral changes). The submission must follow the DOI’s content and format guidance and address each listed item in sequence using clear, consumer‑friendly language.
- Applies to all Issuers who submit Rate Filings for products in the individual and small group single risk pool.
- Required regardless of whether the filing shows a positive, negative, or neutral rate change.
- Must follow the DOI’s specified content requirements, sequence, and use consumer‑friendly language.
Key Terms
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