# S.C. Code Ann. § 38-71-325: SECTION 38-71-325. Requirements for approval of new individual major medical expense coverage policies > South Carolina · Statutes · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-325 ## Section - **Citation:** S.C. Code Ann. § 38-71-325 - **Heading:** SECTION 38-71-325. Requirements for approval of new individual major medical expense coverage policies - **Jurisdiction:** South Carolina - **Kind:** Statutes - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** SC Code / Title 38 / Chapter 71 / Article 3 / Section 38-71-325 ## Text On January 1, 1992, in addition to any other requirements of law, no new individual major medical expense coverage policy, as defined in regulations promulgated by the department, may be approved unless: (1) Premium rates, after appropriate allowance for the actuarial value of the difference in benefits, for any such policy form first approved for use by the insurer in South Carolina within the two-year period immediately prior to the effective date of this section and any such policy form first approved for use after the effective date of this section do not exceed the premium rates for any other such policy form first approved for use during this period by more than thirty percent. (2) The actuarial value of the difference in benefits set out in such policy forms of the insurer, as specified in an opinion by a qualified actuary or other qualified person acceptable to the director or his designee,is reported not less often than once a year to the director or his designee and used in demonstrating compliance with item (1). (3) The anticipated (target) loss ratio for the combined experience for all the policy forms specified in item (1) must be equivalent to or greater than the most recent loss ratios detailed within the National Association of Insurance Commissioner's 'Guidelines for Filing of Rates for Individual Health Insurance Forms' or successor publications. The anticipated (target) loss ratio for the combined experience is defined as the average anticipated (target) loss ratio for all these policy forms included in the combined experience weighted by premium volume. With respect to the policy form, the insurer shall have the right to file a loss ratio guarantee in accordance with the procedures specified in Section 38-71-310(E) or to request approval of any rate change before the use thereof, but the anticipated loss ratios of each policy form whether or not a loss ratio guarantee has been filed must be combined as provided in the preceding item (3). The initial policy form proposed to be used by a domestic insurer after its organization under the laws of this State and the initial policy form proposed to be used by a foreign insurer after authorization by the director or his designee to do business in this State may be disapproved by the director or his designee if he determines that the rates proposed to be used with the policy form are set at a level substantially less than rates charged by other insurers in this State offering comparable coverage. Nothing contained in this section may be construed to prevent the use of age, sex, area, industry, occupational, and avocational factors or to prevent the use of different rates for smokers and nonsmokers or for any other habit or habits of an insured person which have a statistically proven effect on the health of the person and are approved by the director or his designee. Also, nothing contained in this section shall preclude the establishment of a substandard classification based upon the health condition of the insured, but the initial classification may not be changed adversely to the applicant after initial issue. The director or his designee has the right, upon application by any insurer, to grant relief, for good cause shown, from any requirement of this section. ## Nearby sections - [S.C. Code Ann. § 38-71-310 SECTION 38-71-310. Filing of forms and rates; approval or disapproval; withdrawal of approval; exceptions; loss ratio guarantee.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-310.md) - [S.C. Code Ann. § 38-71-315 SECTION 38-71-315. Decrease of premium charges.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-315.md) - [S.C. Code Ann. § 38-71-320 SECTION 38-71-320. Policies issued for delivery in another state.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-320.md) - [S.C. Code Ann. § 38-71-325 SECTION 38-71-325. Requirements for approval of new individual major medical expense coverage policies.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-325.md) - [S.C. Code Ann. § 38-71-330 SECTION 38-71-330. Form of policies.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-330.md) - [S.C. Code Ann. § 38-71-335 SECTION 38-71-335. Accident and/or health insurance cancellation provision prohibited; optionally renewable policies prohibited; notice of nonrenewal.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-335.md) - [S.C. Code Ann. § 38-71-340 SECTION 38-71-340. Required provisions.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-340.md) - [S.C. Code Ann. § 38-71-350 SECTION 38-71-350. Required provision for continuation of coverage for handicapped and dependent children of policyholder.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-350.md) - [S.C. Code Ann. § 38-71-355 SECTION 38-71-355. Dependent child; medically necessary leave of absence.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-355.md) - [S.C. Code Ann. § 38-71-360 SECTION 38-71-360. Continuation of coverage for nonhandicapped dependent children.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-360.md) - [S.C. Code Ann. § 38-71-370 SECTION 38-71-370. Optional provisions.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-370.md) - [S.C. Code Ann. § 38-71-380 SECTION 38-71-380. Medical expense policy; optional intoxicants and narcotics exclusion inapplicable.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-380.md) - [S.C. Code Ann. § 38-71-410 SECTION 38-71-410. Omission or modification of required or optional provisions.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-410.md) - [S.C. Code Ann. § 38-71-420 SECTION 38-71-420. Placement of required and optional provisions in policy.](https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-420.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_SC_T38_C71_A3_S38-71-325. Check the current official text before relying on it. Not legal advice.