Part III Actuarial Memorandum Oscar Insurance Corporation Individual On-Exchange Plans 2016 ...

225 Pages·2015·5.08 MB·English

SERFF Tracking #: OHIN-130063471 State Tracking #: 2015050266 Company Tracking #:
State: New York Filing Company: Oscar Insurance Corporation
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical
Expense
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
Project Name/Number: /
F iling at a Glance
Company: Oscar Insurance Corporation
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
State: New York
TOI: H15I Individual Health - Hospital/Surgical/Medical Expense
Sub-TOI: H15I.001 Health - Hospital/Surgical/Medical Expense
Filing Type: Prior Approval Exchange Rates
Date Submitted: 05/15/2015
SERFF Tr Num: OHIN-130063471
SERFF Status: Assigned
State Tr Num: 2015050266
State Status: CP-xx-IA-xx
Co Tr Num:
Implementation 01/01/2016
Date Requested:
Author(s):
Reviewer(s):
Disposition Date:
Disposition Status:
Implementation Date:

State Filing Description:
PDF Pipeline for SERFF Tracking Number OHIN-130063471 Generated 05/19/2015 02:15 PM
SERFF Tracking #: OHIN-130063471 State Tracking #: 2015050266 Company Tracking #:
State: New York Filing Company: Oscar Insurance Corporation
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical
Expense
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
Project Name/Number: /
G eneral Information
Project Name: Status of Filing in Domicile: Not Filed
Project Number: Date Approved in Domicile:
Requested Filing Mode: Review & Approval Domicile Status Comments:
Explanation for Combination/Other: Market Type: Individual
Submission Type: New Submission Individual Market Type: Individual
Overall Rate Impact: Filing Status Changed: 05/19/2015
State Status Changed: 05/19/2015
Deemer Date: Created By:
Submitted By: Corresponding Filing Tracking Number:
PPACA: Non-Grandfathered Immed Mkt Reforms
PPACA Notes: null
Include Exchange Intentions: No

Filing Description:
On exchange rate adjustment filing
C ompany and Contact
Filing Contact Information
295 Lafayette Street
6th Floor
New York, NY 10012
Filing Company Information
Oscar Insurance Corporation CoCode: 15281 State of Domicile: New York
295 Lafayette Street Group Code: Company Type: Insurance
6th Floor Group Name: State ID Number:
New York City, NY 10012 FEIN Number: 46-2043136
[phone] ext. [Phone]
F iling Fees
Fee Required? No
Retaliatory? No
Fee Explanation:
S tate Specific
1. Is a parallel product being submitted for another issuing entity of the same parent organization? Yes/No (If Yes, enter
name of other entity, submission date, and SERFF Tracking Number of the parallel file.): Yes: Oscar Off-Exchange Prior
Approval Filing, OHIN-130063473
2. Type of insurer? Article 43, HMO, Commercial, Municipal Coop, or Fraternal Benefit Society: Article 42
3. Is this filing for Group Remittance, Statutory Individual HMO, Statutory Individual POS, Blanket, or Healthy New York?
Yes/No (If Yes, enter which one.): No
PDF Pipeline for SERFF Tracking Number OHIN-130063471 Generated 05/19/2015 02:15 PM
SERFF Tracking #: OHIN-130063471 State Tracking #: 2015050266 Company Tracking #:
State: New York Filing Company: Oscar Insurance Corporation
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical
Expense
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
Project Name/Number: /
4. Type of filing? Enter Form and Rate, Form only, Rate only (Form only should be used ONLY when the filing only contains
an application, advertisement, administrative form, or is a group prefiling notification, out-of-state, or a report filing. Form
submissions with no proposed rate impact are considered form and rate filings and require an actuarial memorandum.): Rate
only
5. Is this a Rate only filing? Yes/No [If Yes, enter one: Commission/Fee Schedule, Prior Approval Rate Adjustment, DBL
Loss Ratio Monitoring, Loss Ratio Experience Monitoring/Reporting, Medicare Supplement Annual Filing (other than rate
adjustment), Medicare Supplement Refund Calculation Filing, Timothy's Law Subsidy Filing, Sole Proprietor Rating, 4308(h)
Loss Ratio Report, 3231(e) Loss Ratio Report, Experience Rating Formula, or Other with brief explanation).]: Prior Approval
rate adjustment
6. Does this submission contain a form subject to Regulation 123? Yes/No (If Yes, provide a full explanation in the Filing
Description field.: No
7. Did this insurer prefile group coverage for this group under Section 52.32 prior to this filing? Yes/No (If Yes, enter the
state tracking number assigned and the effective date of coverage.): No
8. Does this submission contain any form which is subject to review by the Life Bureau, the Property Bureau or both? Yes/No
(If Yes, identify the forms, the Bureau, the date submitted, and the SERFF file number.): No
9. Does this filing contain forms that replace any other previously approved forms? Yes/No (If Yes, identify the form
numbers, the file number, and the date of approval of the forms being replaced in the Filing Description field.): No
10. If this is a rate adjustment filing pursuant to Section 3231(e)(1) or 4308(c), did this insurer submit a "Prior Approval
Prefiling" containing a draft narrative summary, a draft initial notification letter, and a draft numerical summary associated with
this filing? Yes/No (If Yes, enter the state tracking number and the SERFF tracking number of the prefile.): Yes
PDF Pipeline for SERFF Tracking Number OHIN-130063471 Generated 05/19/2015 02:15 PM
SERFF Tracking #: OHIN-130063471 State Tracking #: 2015050266 Company Tracking #:
State: New York Filing Company: Oscar Insurance Corporation
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical Expense
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
Project Name/Number: /
C orrespondence Summary
Filing Notes
Subject Note Type Created By Created On Date Submitted
Oscar 2016 Filing Note To Reviewer Tessie Abraham 05/15/2015 05/15/2015
PDF Pipeline for SERFF Tracking Number OHIN-130063471 Generated 05/19/2015 02:15 PM
SERFF Tracking #: OHIN-130063471 State Tracking #: 2015050266 Company Tracking #:
State: New York Filing Company: Oscar Insurance Corporation
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical Expense
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
Project Name/Number: /
R ate Information
Rate data applies to filing.
Filing Method:
Rate Change Type: %
Overall Percentage of Last Rate Revision: %
Effective Date of Last Rate Revision:
Filing Method of Last Filing:
Company Rate Information
Company Overall % Overall % Written Number of Policy Written Maximum % Minimum %
Company Rate Indicated Rate Premium Holders Affected Premium for Change Change
Name: Change: Change: Impact: Change for for this Program: this Program: (where req'd):(where req'd):
this Program:
Oscar Insurance Increase 5.600% 5.600% $398,704,187 12,439 $175,997,990 9.600% -29.900%
Corporation
PDF Pipeline for SERFF Tracking Number OHIN-130063471 Generated 05/19/2015 02:15 PM
SERFF Tracking #: OHIN-130063471 State Tracking #: 2015050266 Company Tracking #:
State: New York Filing Company: Oscar Insurance Corporation
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical
Expense
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
Project Name/Number: /
R ate Review Detail
COMPANY:
Company Name: Oscar Insurance Corporation
HHS Issuer Id: 74289
PRODUCTS:
Product Name HIOS Product ID HIOS Submission ID Number of Covered
Lives
Oscar Classic Bronze 74289NY010 3931
Oscar Classic Gold 74289NY004 1371
Oscar Classic Platinum 74289NY002 335
Oscar Classic Silver 74289NY006 2278
Oscar Market Bronze 74289NY008 2909
Oscar Market Bronze (Child Only) 74289NY013 7
Oscar Market Gold 74289NY003 1848
Oscar Market Gold (Child Only) 74289NY012 4
Oscar Market Platinum 74289NY001 1356
Oscar Market Platinum (Child Only) 74289NY011 12
Oscar Market Secure 74289NY016 5491
Oscar Market Silver 74289NY005 1747
Oscar Market Silver (Child Only) 74289NY014 12
Oscar Simple Bronze 74289NY052 4896
Oscar Simple Gold 74289NY054 2246
Oscar Simple Platinum 74289NY041 2576
Oscar Simple Silver 74289NY050 2142
Trend Factors:
FORMS:
New Policy Forms: Oscar EPO XP Std/NonStd 2016, Oscar EPO XP Catastrophic 2016, Oscar EPO XP
Child Only 2016
Affected Forms:
Other Affected Forms:
REQUESTED RATE CHANGE INFORMATION:
Change Period: Annual
Member Months: 986,721
Benefit Change: None
Percent Change Requested: Min: -29.9 Max: 9.6 Avg: 5.6
PRIOR RATE:
Total Earned Premium: 175,997,990.00
Total Incurred Claims: 159,739,619.00
Annual $: Min: 166.22 Max: 553.48 Avg: 382.59
PDF Pipeline for SERFF Tracking Number OHIN-130063471 Generated 05/19/2015 02:15 PM
SERFF Tracking #: OHIN-130063471 State Tracking #: 2015050266 Company Tracking #:
State: New York Filing Company: Oscar Insurance Corporation
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical
Expense
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
Project Name/Number: /
REQUESTED RATE:
Projected Earned Premium: 398,704,187.00
Projected Incurred Claims: 365,322,090.00
Annual $: Min: 113.96 Max: 593.46 Avg: 404.07
PDF Pipeline for SERFF Tracking Number OHIN-130063471 Generated 05/19/2015 02:15 PM
SERFF Tracking #: OHIN-130063471 State Tracking #: 2015050266 Company Tracking #:
State: New York Filing Company: Oscar Insurance Corporation
TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical Expense
Product Name: Oscar 2016 On-Exchange Prior Approval Filing
Project Name/Number: /
R ate/Rule Schedule
Item Schedule Affected Form Numbers
No. Item Document Name (Separated with commas) Rate Action Rate Action Information Attachments
Status
1 Oscar Rate Manual 2016 OnEx New NY On HIX Rate
Manual 2016.pdf,
PDF Pipeline for SERFF Tracking Number OHIN-130063471 Generated 05/19/2015 02:15 PM
295 Lafayette St, 6th Floor
New York, NY 10012

Oscar Insurance Corporation
Rate Manual for On-Exchange Products

New York
January 1, 2016

295 Lafayette Street, 6th Floor, New York, NY 10012
TABLE OF CONTENTS

Topic Page No.

Product Name & Benefit Descriptions 3

Premium Rates 8

Rating Regions 10

Rating Classes 11

Commissions 12

Underwriting Guidelines 13
Expected Loss Ratio 14