(a) State MLR standard. The State must describe its current MLR standard for the individual market, if any, and the formula used to assess compliance with such standard.
(b) State market withdrawal requirements. The State must describe any requirements it has with respect to withdrawals from the State's individual health insurance market. Such requirements include, but are not limited to, any notice that must be provided and any authority the State regulator may have to approve a withdrawal plan or ensure that enrollees of the exiting issuer have continuing coverage, as well as any penalties or sanctions that may be levied upon exit or limitations on re-entry.
(c) Mechanisms to provide options to consumers. The State must describe the mechanisms available to the State to provide consumers with options in the event an issuer withdraws from the individual market. Such mechanisms include, but are not limited to, a guaranteed issue requirement, limits on health status rating, an issuer of last resort, or a State-operated high risk pool. A description of each mechanism should include detail on the issuers participating in and products available under such mechanism, as well as any limitations with respect to eligibility, enrollment period, total enrollment, and coverage for pre-existing conditions.
(d) Issuers in the State's individual market. Subject to Sec. 158.320 of this subpart, the State must provide:
(1) For each issuer who offers coverage in the individual market in the State its number of individual enrollees by product, available individual premium data by product, and individual health insurance market share within the State; and
(2) For each issuer who offers coverage in the individual market in the State to more than 1,000 enrollees, the following additional information:
(i) Total earned premium on individual market health insurance products in the State;
(ii) Reported MLR pursuant to State law for the individual market business in the State;
(iii) Estimated MLR for the individual market business in the State, as determined in accordance with Sec. 158.221 of this part;
(iv) Total agents' and brokers' commission expenses on individual health insurance products;
(v) Estimated rebate for the individual market business in the State, as determined in accordance with Sec. Sec. 158.221 and 158.240 of this part;
(vi) Net underwriting profit for the individual market business and consolidated business in the State;
(vii) After-tax profit and profit margin for the individual market business and consolidated business in the State;
(viii) Risk-based capital level; and
(ix) Whether the issuer has provided notice of exit to the State's insurance commissioner, superintendent, or comparable State authority.