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United Am. Ins. Co. v. Insurance Dep't of the State of Ga.

Medsup insurer's must use a reasonable interest assumption in determining their loss ratio—the rate of premium dollars collected to claim dollars paid.

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We granted United American Insurance Company’s application to appeal after the superior court affirmed the decision of the Georgia Insurance Commissioner to disapprove United American’s 2000 rate filings for its Medicare Supplement policies. In four enumerations of error, United American contends the commissioner’s order was erroneous and the superior court erred in affirming it. We do not agree, and we affirm.

The type of insurance involved in this appeal is known in the industry as Medsup. The policies insure against medical costs not covered by Medicare. Georgia began regulating such policies in 1989. Ga. L. 1989, p. 1276. In 1990 the federal government became involved in their regulation. Under the Omnibus Budget Reconciliation of 1990, the terms of all new Medsup policies were standardized. Existing policies could be renewed, however, and became known as “prestandardized” policies. Federal regulations were promulgated to set minimum standards for states in their regulation of Medsup policies. The National Association of Insurance Commissioners NAIC then developed model state statutes and regulations for Medsup insurance rates and forms. Georgia’s original Medsup statutes were repealed in 1992, and they were replaced with the model statutes. OCGA § 33-43-1 through §33-43-9. The Georgia Department of Insurance also adopted the new model Medsup regulations drafted by NAIC. Ga. Comp. R. & Regs., r. 120-2-8 et seq.

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