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PA Bulletin, Doc. No. 01-1528


Blue Cross of Northeastern Pennsylvania, Pennsylvania Blue Shield and First Priority Health; Age-Gender-Industry Rating; Rate Filing

[31 Pa.B. 4609]

   To achieve consistency in rating across the community rated product lines of Blue Cross of Northeastern Pennsylvania, Pennsylvania Blue Shield and First Priority Health, on July 9, 2001, these plans submitted a filing to request the Insurance Department's approval to utilize a common Age-Gender-Industry Rating methodology for Traditional, PPO (that is, Access Care II) and FPH (that is, HMO and POS) community rated groups. For new business, the methodology defines a ''Community Rated'' group as an employer group that has two eligible contracts up to a maximum of 50 eligible contracts for enrollment in BCNEPA/PBS (including Traditional and PPO) and/or FPH. For existing business, a ''Community Rated'' group will be defined as an employer group that has a minimum of two enrolled contracts up to a maximum of 50 enrolled contracts in any combination of BCNEPA/PBS and FPH.

   The proposed Age-Gender-Industry Rating methodology will be applicable to the following community rated products: Blue Cross Basic, Blue Shield Medical-Surgical, Major Medical (with/without Rx), Blue Cross Prescription Drug Rider, Access Care II Hospital, Access Care II Rx Rider, Access Care II Medical-Surgical, First Priority Health HMO and First Priority Health POS. The proposed methodology will not be applicable to Blue Shield Dental and Vision Riders at this time. In addition, because its pool of subscribers already reflects a narrowly defined age pool, the methodology will not be used to adjust rates for the 65 Special Community group product.

   This filing is available for public inspection during normal working hours on the 13th floor, Strawberry Square, Harrisburg PA 17120.

   Interested parties are invited to submit written comments, suggestions or objections to Cherri Sanders-Jones, Actuary, Insurance Department, Strawberry Square, Harrisburg, PA 17120 within 15 days after the publication of this notice in the Pennsylvania Bulletin.

Insurance Commissioner

[Pa.B. Doc. No. 01-1528. Filed for public inspection August 17, 2001, 9:00 a.m.]

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