Section 151.16 - Health Benefit Plans Offered By Carriers through Certified Group Purchasing Cooperatives(1) As a condition of continued offer of small group insured Health Benefit Plans, a Carrier that, as of the close of the preceding calendar year, has a combined total of at least 5,000 Eligible Individuals, Eligible Employees and Eligible Dependents who are enrolled in Health Benefit Plans sold, issued, delivered, made effective or renewed shall be required to annually file a Health Benefit Plan and accompanying rates according to the Health Benefit Plan specifications developed by a certified Group Purchasing Cooperative for the Group Purchasing Cooperative's consideration, if said certified Group Purchasing Cooperative requests such Health Benefit Plan proposals for its next plan year.(2) Acceptable Health Benefit Plan features shall include, but not be limited to, the following: (a) All Health Benefit Plans offered by a Carrier through each certified Group Purchasing Cooperative are to include Mandated Benefits and comply with all additional relevant statutory and regulatory requirements for insured Health Benefit Plans.(b) For Eligible Small Businesses or Qualified Associations of five or fewer Eligible Employees or Eligible Association Members, a Carrier may require a Participation Rate not to exceed 100%. For Eligible Small Businesses or Qualified Associations of six or more Eligible Employees or Eligible Association Members, a Carrier may require a Participation Rate not to exceed 75%.(c) Pre-existing condition limitations and Waiting Periods are to be applied by a Carrier within Health Benefit Plans offered through each certified Group Purchasing Cooperative in the same manner that they are applied to individuals and small employer groups enrolling in coverage outside the certified Group Purchasing Cooperative.(d) Continuation of coverage provisions are to be applied by a Carrier within Health Benefit Plans offered through each certified Group Purchasing Cooperative in the same manner that they are applied to individuals and small employer groups enrolling in coverage outside the certified Group Purchasing Cooperative.(e) Managed care practices, including utilization review, quality assurance, credentialing of health plan providers, and dissemination of required consumer materials are to be applied by a Carrier within a Health Benefit Plan offered through each certified Group Purchasing Cooperative in the same manner that they are applied to individuals and small employer groups enrolling in coverage outside the certified Group Purchasing Cooperative.(3) Requirements of Premium Rates Offered by Carriers are as follows: (a) For all rates offered by a Carrier through each certified Group Purchasing Cooperative, the Carrier shall apply rating rules, including rating bands, rating factors and the value of rating factors in the same manner as the Carrier applies those rules to insured Health Benefit Plans offered to individuals and small employer groups outside the certified Group Purchasing Cooperative.(b) Carriers may submit a rate filing with respect to any cooperative adjustment factor, benefit adjustment factor, or limited deviation, and Carriers may apply for the Commissioner's approval to make limited deviations from required application of rating factors.(c) The rates offered by a Carrier through each certified Group Purchasing Cooperative shall be based on those group base premium rates that apply to individuals and small employer groups enrolling outside the Group Purchasing Cooperative but may differ based as follows: 1. A benefit rate adjustment factor that is applied to the certified Group Purchasing Cooperative product if its Covered Benefits are different than those outside the certified Group Purchasing Cooperative;2. A cooperative adjustment factor that reflects the relative difference in the projected experience of the members projected to be enrolled in Health Benefit Plans through the certified Group Purchasing Cooperative relative to the projected experience of the members projected to be enrolled in Health Benefit Plans outside the certified Group Purchasing Cooperative; and3. Any other rate adjustment factor that has received written prior approval from the Commissioner.