Insurance Commissioner v. CareFirst of Maryland, Inc.

ADKINS, J. In this case, two non-profit health insurers seek to limit the scope of the authority held by the Maryland Insurance Commissioner (the “IC”) to regulate insurance rates proposed by them. Appellees CareFirst of Maryland, Inc. (“CareFirst”) and Group Hospitalization & Medical Services, Inc. (“GHMSI”)(together referred to as “the insurers”) challenge the IC’s right to venture outside strict actuarial concerns (1) in deciding to disapprove the insurers’ proposed rate increases as excessive, and (2) in treating as income the benefit of a subsidy or discount earned by the insurers because they were ⁴⁵³ willing to offer certain open enrollment insurance known as “SAAC products” to high risk individuals. The insurers also challenge the method that the IC used to set new rates after he disapproved the rates they proposed. We hold that the IC acted within his authority, both in disapproving the rate increases requested by the insurers, and in modifying those rates.

FACTUAL AND LEGAL PROCEEDINGS The history of a Maryland independent agency known as the Health Services Cost Review Commission (“HSCRC”) provides the backdrop to this case. The HSCRC was established by the General Assembly to regulate the rates charged by hospitals and other related institutions. See Health Svcs. Cost Review Comm’n v. Franklin Square Hosp., 280 Md. 233, 234-38 , 372 A.2d 1051 (1977).

It reviews such rates to determine whether they are reasonable, and if so, approves them. See Md.Code (1982, 2000 Repl.Vol, 2002 Cum.Supp.), § 19-211(a)(1), § 19-219 of the Health-General Article. In 1974, the HSCRC observed that “some practices of major third parties either reduced hospital costs or averted bad debts.” At that time, Maryland Blue Cross/Blue Shield, Care-First’s predecessor, offered an “open enrollment” health care policy for individuals, which enabled an applicant to obtain health insurance without regard to his or her health condition. The HSCRC concluded that the availability of such insurance coverage for high risk individuals resulted in a reduction in the amount of uncompensated or “bad debt” care that hospitals would otherwise have been required to provide if those high risk individuals had not been able to obtain insurance.

In order to encourage other insurers to offer such open enrollment coverage, the HSCRC developed the “SAAC” program. The acronym “SAAC” stands for “Substantial, Available, and Mfordable Coverage.” Under this program, any insurer wdio offers a product meeting the SAAC criteria is entitled to a 4% discount from HSCRC-approved hospital rates for the services that Maryland hospitals provide to its ⁴⁵⁴ subscribers. 1 The amount of this discount, known as the “SAAC differential,” was “designed to reflect the cost savings to hospitals by carriers offering ... SAAC.” Once an insurer qualifies for the SAAC differential, the 4% discount applies, not only when health services are provided to those patients purchasing the qualified insurer’s SAAC product, but also when services are provided to other persons insured by that carrier under non-SAAC policies. A carrier is required to apply for the SAAC differential each year, and, in doing so, to demonstrate that it meets the criteria specified by the HSCRC.

See COMAR 10.37.10.26A(6). Interestingly, the cost savings to the hospitals from having SAAC insurance available dramatically exceeded the loss that the insurers incurred in providing insurance to these high-risk individuals. Because the 4% discount was predicated on the hospital’s savings resulting from SAAC coverage, rather than the cost to the insurers, the latter received a large “profit” from the SAAC differential. According to a 2001 HSCRC staff report, the value of the SAAC differential to CareFirst was $26,089,900 in 2000, and was projected to be $27,000,000 for the year 2001.

The value of the SAAC differential to GHMSI was $4,600,190 in 2000, and was projected to be $4,900,000 for the year 2001. In 2001, the General Assembly, recognizing this differential, funded a Short-Term Prescription Drug Subsidy Plan by requiring each insurer receiving the SAAC differential to contribute 37.5% of the discount to the Plan. See 2001 Md. Laws ch. 135; codified at Md.Code (1997, 2002 Repl.Vol., 2002 Cum.Supp.), § 15-606(c) of the Insurance Article (“Ins.”). With a 37.5% reduction, the net SAAC differential still avail ⁴⁵⁵ able to CareFirst would be $16,875,000 for 2001.

The net SAAC differential still available to GHMSI would be $8,062,500 for 2001. 2 The dispute in this case arose when the IC took the SAAC differential into consideration in disapproving the insurers’ proposals to increase premiums for their SAAC products. Rates charged by a non-profit health insurer to its subscribers must first be “submitted to and approved by the” IC. See Md.Code (1997, 2002 Repl.Vol.), § 14-126(a) of the Insurance Article (“Ins.”) Alter evaluating a proposed change in rates, the IC “shall disapprove or modify the proposed [rate] change” whenever, inter alia, “the table of rates appears by statistical analysis and reasonable assumptions to be excessive in relation to benefits[.]” Ins. § 14—126(b) (3)(i). On March 9, 2001, the insurers submitted to the Maryland Insurance Administration (“MIA”) new rate filings that contained substantial rate increases for certain SAAC products.

In support, the insurers provided extensive actuarial information relating to the costs and expenses of the SAAC products. According to these filings, the insurers proposed two contracts, the first to existing SAAC subscribers, with the same level of benefits that had been provided in the past (“the old SAAC product”). The second was offered to new subscribers after June 1, 2001 (“the new SAAC product”), which contained additional benefits required by the Maryland Health Care Commission. All new subscribers would be required to purchase the new SAAC product, which contained more benefits and carried a higher premium.

Under the new scheme, the proposed monthly rates increased as the age of the insured increased, a practice known as “age banding.” Depending on the age of the insured, the increases for new CareFirst SAAC customers ranged from 65% to 578%. The rate changes for new GHMSI SAAC customers ranged from a 5.7% decrease to a 270% increase. ⁴⁵⁶ The following percentages of increase were proposed by the insurers: EXISTING [CAREFIRST! SAAC PRODUCT _Current New Increase Over Existing SAAC Rates _$_% 25 $131 $197 $66_50.4% 35 $131 $197 $66_50.4% 45 $131 $197 $66_50.4% 55 $131 $197 $66_50.4% 65 $131 $197 $66_50.4% NEW [CAREFIRST] SAAC PRODUCT WITH AGE BANDING Current New Increase Over Existing SAAC Rates 25 $217 86 65.6% 35 $266 $135 103.1% 45 $396 $265 202.3% 55 — $622 $491 374.8% 65 — $889 $758 578.6% EXISTING [GHMSI] SAAC PRODUCT Current New Increase Over Existing SAAC Rates % 25 $210 $316 $106 50.5% 35 $210 $316 $106 50.5% 45 $210 $316 $106 50.5% 55 $210 $316 $106 50.5% 65 $210 $316 $106 50.5% NEW [GHMSI] SAAC PRODUCT WITH AGE BANDING Current New Increase Over Existing SAAC Rates ⁴⁵⁷ 25 — $198 ($ 12) -5.7% 35 — $242 $ 32 15.2% 45 — $397 $187 89.0% 55 — $496 $286 136.2% 65 — $778 $568 270.5% On April 13, 2001, the MIA disapproved the requested rate changes. In rejecting the proposed rates, the MIA “determined that the proposed rates were excessive in relation to the benefits provided, considering the value received by [the insurers.]” At the insurers’ request, a hearing was held before the IC, Steven B. Larsen.

The insurers’ actuary testified that, under the rate schedules proposed by the insurers, the premium revenues would be less than the expected expenses and cost of claims. Thus, the actuary said, the “losses” to the insurers would be even greater under the lower rates approved by the MIA. He calculated that under the rates approved by the MIA, Care-First would suffer a “loss” of $1,400,000 on SAAC contracts in 2001, while GHMSI would suffer a “loss” of $2,100,000. In his calculations, however, the insurers’ actuary did not include the value to the insurers of the SAAC differential generated by the 4% discount that would be applied to its non-SAAC insureds.

Once the value of the SAAC differential was accounted for, the losses on the SAAC policies disappeared, because the SAAC differential greatly exceeded the amount of the “losses” as the actuary had calculated them. At the hearing before the IC, the statistical data was not in dispute. Rather, the insurers challenged the IC’s authority to consider the SAAC differential in reviewing the SAAC rates. They presented the testimony of Harold Cohen, who was the Executive Director of the HSCRC from 1972 to 1987.

Cohen explained the development of the SAAC differential and opined that “the proper application of cost savings realized as ⁴⁵⁸ a result of SAAC should be left to either the [HSCRC] or the Maryland General Assembly.” Cohen’s testimony, however, was contradicted by the HSCRC’s February 1986 29-page Final Decision that was issued while Cohen was Executive Director (the “Final Decision”). In this Final Decision, the HSCRC set forth the final amount of the SAAC discount, expressly concluded that it was the job of the IC, and not that of the HSCRC, to consider the amount of the SAAC differential in setting insurance rates, and expressly recommended that the IC “consider whether premium adjustment should be made.” In this document, the HSCRC discussed the purposes of the SAAC program, and recognized that “[i]t would not be equitable ... for Blue Cross to charge higher rates that more than cover the claims of this class of insured and receive a differential for providing this coverage. This practice amounts to a double reward.” (Emphasis in original.) The Final Decision also recognized that the SAAC differential may give an “excessive competitive advantage” to the insurers who receive it, by allowing them to lower the price of all their products rather than lowering only the price of the SAAC product. In the Final Decision, the HSCRC expressed its view that [i]t is within the authority of the Insurance Commissioner to adjust and/or limit the premiums which Blue Cross/Blue Shield may charge its customers for SAAC policies in order to adjust its ultimate revenue....

The [HSCRC] does not wish to overstep its jurisdictional bounds as it relates to the business of insurance; therefore, it recommends that the Insurance Commissioner consider whether premium adjustment should be made. The IC also heard testimony fi-om Robert Murray, the Executive Director of the HSCRC at the time of the hearing. Murray testified that HSCRC intended that the SAAC differential would subsidize the cost of the SAAC product, and that the HSCRC “want[ed] there to be a subsidy for the product itself to make sure that it remained affordable.” In Murray’s view, “[t]he differential was applied company-wide under the ⁴⁵⁹ expectation that the entire value or a portion of the value of the differential would be transferred to the open enrollment product and the other qualifying products at the time in order to keep these products substantial and affordable.” In a written opinion, the IC upheld the MIA’s determination that the requested rate increases were excessive. The IC concluded that the “HSCRC intended the SAAC product to be ‘affordable’, and that the model for the program w;as the historical practice of CareFirst of Maryland to offer a product priced at or near the level of medically underwritten products.” He concluded that “the record shows a clear recognition by the HSCRC of the ongoing jurisdiction of the MIA to review SAAC rates.” Rejecting the insurers’ argument that the imbalance between the SAAC differential and the losses sustained by a SAAC carrier ought to be addressed by the HSCRC, the IC determined that the MIA was the agency with the authority to review insurance rates and to determine whether they were “excessive in relation to benefits” under section 14-126 of the Insurance Article.

He found that the HSCRC intended that “the MIA should take into consideration the policy underlying the SAAC program and the value of the discount received by a carrier when reviewing the rates of a SAAC product.” The IC also rejected the insurers’ argument that the HSCRC’s power to disapprove a carrier as a participant in the SAAC program addressed any concerns about affordability of rates for SAAC customers: It is true that the HSCRC has provided little guidance on what would appear to be a key element of the SAAC program; namely, that the product be affordable. However, the fact that the HSCRC has, from its perspective as a hospital rate regulator, approved the SAAC applications of GHMSI and CareFirst of Maryland in no way trumps the ... statutory authority of the MIA to separately review rates and to consider all relevant factors.... The regulation of SAAC is clearly joint regulation, with each agency charged to oversee those aspects of the program for which it has the requisite expertise. ⁴⁶⁰ The insurers appealed the IC’s rate decision to the Circuit Court for Baltimore City. The circuit court reversed, holding that the IC had acted outside of his authority in disapproving the insurers’ proposed rates.

This appeal followed. DISCUSSION Section 14-126 of the Insurance Article, titled “Filings of amendments and rate changes,” is the exclusive source of the IC’s authority to approve or disapprove rates charged by nonprofit insurers. See The Johns Hopkins Hosp. v. Ins. Comm’r, 302 Md. 411, 419-20 , 488 A.2d 942 (1985).

It provides, in pertinent part: (a) Approval by Commissioner required.— (1) A corporation subject to this subtitle may not amend ... the terms and provisions of contracts issued or proposed to be issued to subscribers to the plan until the proposed amendments have been submitted to and approved by the Commissioner .... (b) ... (3)(i) The Commissioner shall disapprove or modify the proposed change if ... the table of rates appears by statistical analysis and reasonable assumptions to be excessive in relation to benefits .... (ii) In determining whether to disapprove or modify the ... table of rates, the Commissioner shall consider: 1. past and prospective loss experience within and outside the State; 2. underwriting practice and judgment to the extent appropriate; 3. a reasonable margin for reserve needs; 4. past and prospective expenses, both countrywide and those specifically applicable to the State; and 5. any other relevant factors within and outside the State.

The insurers offer several arguments to support the circuit court’s decision to reverse the IC, and in each they invite us to circumscribe the IC’s authority under section 14-126. Addressing each argument in turn, we decline this invitation. ⁴⁶¹ I. Insurers’ Arguments That the IC Must Limit His Consideration To Statistical Analysis of Actuarial Factors, And That He Exceeded His Authority In Relying On Policy Concerns In Disapproving The Insurers’ Proposed Rates The insurers’ primary argument is that the IC exceeded his authority under section 14—126(b)(3)(i)(l) to disapprove rates if “the table of rates appears by statistical analysis and reasonable assumptions to be excessive in relation to benefits[.]” The insurers first assert that the IC failed to exercise this statutory authority because he did not perform any statistical analysis. A. Statistical Analysis The insurers contend that the legislature, in using the terminology “statistical analysis” and “reasonable assumptions,” “clearly ... intended to limit the [IC] to considering actuarial factors when exercising his power to disapprove rates.” The insurers invoke the familiar statutory construction doctrine of ejusdem generis to define and limit the broad language in section 14-126(b)(3) allowing the IC to consider “any other relevant factors” in disapproving and modifying the proposed rate changes. Under this doctrine, they assert, the IC’s consideration of other factors is limited to items that are similar in nature to the enumerated factors in items 1 though 4 of subsection 14—126(b)(3)(ii), all of which, they contend, are actuarial.

See, e.g., Rucker v. Harford County, 316 Md. 275, 295 , 558 A.2d 399 (1989)(the doctrine of ejusdem generis means that when general words in a statute follow the designation of particular things, the general words are construed to include only those things of the same class or general nature as those specifically enumerated). The IC’s consideration of the intent and policy of the HSCRC in creating the SAAC differential was not actuarial, they argue, but rather a policy concern that the IC was forbidden to consider. ⁴⁶² We shall hold in section II that the doctrine of ejusdem generis does not preclude the IC from considering non-actuarial factors pursuant to section 14—126(b). Analysis of that issue is not required yet, however, because we preliminarily conclude that consideration of the SAAC differential is both statistical and actuarial. We reach this conclusion simply by reference to legal and English language dictionaries. “Statistics” means “the science that deals with the collection, classification, analysis, and interpretation of numerical facts or data, and that, by use of mathematical theories of probability, imposes order and regularity on aggregates of more or less disparate elements.” The Random House Dictionary of the English Language 1389 (unabr. ed.1973).

A “statistic” is defined as “a numerical fact or datum.” Id. Clearly, the SAAC differential, a concrete and definite dollar figure determined by taking a fraction (4%) of the cost of hospital services to the insurers’ subscribers, is statistical information. Black’s Law Dictionary defines “actuary” as “[a] statistician who determines the present effects of future contingent events; esp., one who calculates insurance and pension rates on the basis of empirically based tables.” Black’s Law Dictionary 37 (7th ed.1999). Random House Dictionary defines “actuary” as “a person who computes premium rates, dividends, risks, etc., according to probabilities based on statistical records.” See Random House Dictionary, supra, at 15.

We have no doubt that data reflecting the amount that the insurers saved in hospital charges because of the SAAC differential is information that can be used in actuarial analysis because it is statistical, is empirically based, relates to the cost of providing SAAC policies, and can be used to predict the amount of subsidy to be received by the insurers in the upcoming year. It relates to the SAAC policies because, indisputably, the insurers would lose the 4% discount from the hospitals if they did not offer the SAAC policies. That a substantial portion of the SAAC differential is received when non-SAAC subscribers obtain hospital services ⁴⁶³ does not deprive the SAAC differential of its status as a statistic used in an actuarial analysis. We therefore hold that, in considering the SAAC differential in his decision, the IC used “statistical analysis” within the meaning of section 14-126(b)(3). 3 This conclusion does not necessarily mean that the statistical analysis performed by the IC was free of the policy concerns that appellants consider inappropriate.

We turn next to that aspect of the insurers’ argument. B. Policy Concerns The insurers insist that, even if the SAAC differential is statistical and actuarial in nature, the IC could not consider it in deciding that the proposed SAAC rates were excessive because, in doing so, he was making a policy decision, which goes beyond his actuarial role. His policy decision favored the interests of the high risk subscribers by making their premiums lower. We agree with the insurers that the IC took into account the policy decision of the HSCRC to give insurers incentives to offer affordable insurance to high risk individuals.

We do not agree that in doing so, he exceeded his authority. We explain. As the IC points out, “[i]f the insurers stopped offering the SAAC product, they would no longer be eligible for the SAAC differential, and would have to pay the hospital charges that the SAAC differential represents.” The IC merely recognized the undisputed causal relationship between the insurers’ offering of SAAC differential policies and the insurers’ receipt of benefits in the form of a discount. This simple reality reinforces the logic that the SAAC differential should be credited to the SAAC product.

Nor is the IC’s concern about providing affordable coverage to SAAC subscribers an improper policy consider ⁴⁶⁴ ation outside of his jurisdictional realm. The IC has a legitimate interest in seeing that the insurance provided by nonprofit health service plans provides the best insurance at a reasonable cost to the most people. The IC’s power to advance this interest is implicit in his authority to disapprove rates if they are “excessive in relation to benefits,” and his authority to disapprove insurance forms that are “unjust or unfair.” See Ins. § 14—126(b)(3)(!)(1)—(2). See also 1-3 Holmes’ Appleman on Insurance 2d § 3.7 (2002)(“Rate regulation is designed to generate premium charges that are equitable for each policyholder-insured as well as yield insurers a fair return for the risks undertaken”).

When a large economic benefit accrues to the insurers as a result of a state program designed to promote affordable insurance for high risk individual subscribers, it can be considered inequitable to ignore that benefit when calculating rates for those high-risk individuals. This is particularly so when the proposed rates substantially exceed those charged group insurance subscribers. The Court of Appeals made it clear' in The Johns Hopkins Hosp., Inc. v. Ins. Comm’r, 302 Md. 411 , 488 A.2d 942 (1985), that the insurance commissioner may consider a State policy regarding health care that was established by another agency as a “relevant factor” within the meaning of section 14-126(b)(3).

In Johns Hopkins Hosp., the insurance commissioner had approved a form of insurance contract submitted by Blue Cross of Maryland, Inc., that excluded from coverage “high cost” hospitals, as defined in the contract. A number of hospitals challenged this approval, claiming that it was the job of the HSCRC, and not the insurance commissioner, to regulate the rates charged by hospitals. Rejecting this contention, the Court of Appeals broadly interpreted the “any other relevant factors” language of section 14-126(b)(3): “In today’s complex society it is not possible, nor is it desirable, so to limit the area of concern of one administrative agency that, it does not touch upon that of other agencies. It is not only appropriate but in many instances ⁴⁶⁵ necessary, in pursuing state policy goals that two or more agencies of State government take action within the ambit of their express powers to accomplish the desired objective.

Certainly, if health care cost containment is State policy, such would be among the ‘relevant factors’ which the Commissioner is enjoined by [§ 14—126(b)(3)] to consider.... The Commissioner has not exceeded the scope of his authority nor has he attempted to exercise power and authority delegated to other agencies. In light of the limited judicial role, coordination of the efforts of separate State agencies in seeking to achieve common goals is beyond the responsibility, authority and power of the Court.” Id. at 419-20, 488 A.2d 942 (quoting trial court)(emphasis added and citations omitted). The Court’s broad interpretation of the “any other factors” language as permitting the insurance commissioner to consider cost containment policies adopted by the HSCRC instructs us that, in this instance, the scope of the IC’s inquiry is not as “policy-limited” as the insurers contend.

Here, the IC relied on the historical record of the HSCRC, including its 1986 Final Decision, and the testimony of its Executive Director, Robert Murray. A review of the entire record does not support the narrow reading of the statute advanced by CareFirst. First, the testimony by the current Executive Director of the HSCRC, as well as the decisions of the HSCRC, confirm that it has been accepted and understood] that the MIA would regulate the rates of SAAC products with consideration of the purpose of the SAAC program as well as the value of the discount to a particular SAAC carrier.... [T]he record shows that the HSCRC intended the SAAC product to be “affordable,” and that the model for the program was the historical practice of CareFirst of Maryland to offer a product priced at or near the level of medically underwritten products. The IC quoted from the HSCRC’s 1986 Final Decision: “[T]here is substantial testimony that [the non-profit insurer] charges two to three times as much for a policy issued ⁴⁶⁶ during open enrollment as it does for the same coverage obtained through group or with evidence of insurability.

It would not be equitable, the Commission believes, for [this insurer] to charge higher rates that more than cover the claims of this class of insureds and receive a differential for providing this coverage. This practice amounts to a double reward.” In relying on administrative decisions of the HSCRC when he considered the SAAC differential to set rates, the IC was not drawing upon the HSCRC’s power. He was acting cautiously to ensure that he did not encroach upon the authority of the HSCRC to regulate the SAAC program. We think that one agency has the authority to consider administrative decisions of another agency, and the policy reasons underlying those decisions, in deciding whether and how to exercise its own authority over an overlapping subject matter.

See Johns Hopkins Hosp., 302 Md. at 419-20 , 488 A.2d 942 .

II

The Insurers’ Ejusdem Generis Argument The insurers’ invocation of the doctrine of ejusdem generis does not dissuade us from our view that the IC acted within his authority. This tool of statutory construction is more commonly used to interpret criminal statutes because they must be narrowly construed. See In re Wallace W., 333 Md. 186, 191 , 634 A.2d 53 (1993). “The doctrine ... applies when the following conditions exist: (1) the statute contains an enumeration by specific words; (2) the members of the enumeration suggest a class; (3) the class is not exhausted by the enumeration; (4) a general reference supplementing the enumeration, usually following it; and (5) there is not clearly manifested an intent that the general term be given a broader meaning than the doctrine requires.” Id. at 190 , 634 A.2d 53 (quoting 2A Sutherland Stat. Construction § 47.18, at 200 (5th ed.1992)). ⁴⁶⁷ “ ‘It is generally held that the rule of ejusdem generis is merely a rule of construction and is only applicable where legislative intent or language expressing that intent is unclear.’ ” Id.(quoting Sutherland, supra). “The general words [of the statute] will not be restricted in meaning if upon a consideration of the context and the purpose of the particular statutory provisions as a whole it is clear that the general words were not used in the restrictive sense.” State Dep’t of Assessments & Taxation v. Belcher, 315 Md. 111 , 121, 553 A.2d 691 (1989). The doctrine often has been applied to statutes featuring lists of specific “things.” For example, in In re Wallace W., a statute prohibited the unauthorized use of “ ‘any horse, mare, colt, gelding, mule, ass, sheep, hog, ox or cow, or any carriage, wagon, buggy, cart, boat, craft, vessel, or any other vehicle including motor vehicle as defined in the laws of this State relating to such, or property whatsoever[.]’ ” In re Wallace W, 333 Md. at 190 , 634 A.2d 53 (citation omitted).

A juvenile was adjudged delinquent for violating this statute by taking money from a classmate’s purse. The Court of Appeals held that ejusdem generis applied because the list created two groups—• livestock and vehicles that travel on land or water—and the “other property” mentioned in the statute should be understood to be other property “in the ‘same class or general nature’ as livestock and land or water vehicles.” Id. at 191 , 634 A.2d 53 . It rejected the State’s argument that the juvenile’s unauthorized use of the money in the purse fell within the statute because that reading would mean that “all property would be subject to the unauthorized use statute,” contrary to the recognized purpose of the statute to single out “mobile” personal property for special treatment. See id. at 193-94 , 634 A.2d 53 .

In another criminal case, Choi v. State, 316 Md. 529, 547 , 560 A.2d 1108 (1989), the governing statute made it a misdemeanor “ ‘to make a false statement, report, or complaint’ ” to police “ ‘with intent to cause an investigation or other action to be taken as a result thereof.’ ” (Citation omitted.) The Court of Appeals held that “or other action” meant an action “of the ⁴⁶⁸ same general nature as the initiation of an investigation,” and did not mean making a false statement in response to a question from a police officer who was already investigating. See id. The doctrine was applied in a civil licensing case in Linkus v. Md. State Bd. of Heating Ventilation, Air-Conditioning, Refrigeration Contractors, 114 Md.App. 262 , 689 A.2d 1254 (1997). There, the statute permitted the licensing board to deny an application for a license for any one of 11 listed reasons.

One of the enumerated reasons was if the applicant “ ‘willfully or deliberately disregarded and violated building codes, electrical codes, or laws of the State or of any municipality, city, or county of the State[.]’ ” Id. at 275 , 689 A.2d 1254 (citation omitted). When the Board denied Linkus’ application based on his prior rape conviction,- the Court of Appeals applied ejusdem generis in holding that “other laws of the State” did not include all criminal laws, but meant laws similar to electrical and building codes. See id. at 280-88 , 689 A.2d 1254 . The Court noted that the purpose of the statute was to ensure that contractors “possess[ed] the technical qualifications necessary competently to install and service HVACR systems.” See id. at 280 , 689 A.2d 1254 .

The long list of other factors in the statute was consistent with that interpretation. In Rucker v. Harford County, 316 Md. 275 , 558 A.2d 399 (1989), another civil case, the statute at issue provided that “ ‘[t]he government of each county shall furnish an office for the sheriff and pay the necessary expenses for telephones, stationary] and for other purposes[.]’ ” Rucker, 316 Md. at 294 , 558 A.2d 399 (citation omitted). The Court of Appeals rejected the Attorney General’s argument that “other purposes” included claims for tortious actions by deputy sheriffs. See id. at 295-96 , 558 A.2d 399 .

Applying ejusdem generis to the statute, the Court held that the statute contemplated only office-related expenses comparable to those listed in the statute, all of which were “necessary for the operation of the sheriffs function.” Id. ⁴⁶⁹ The doctrine often has been rejected. See, e.g., Wesley Chapel Bluemount Ass’n v. Baltimore County, 347 Md. 125, 144-47 , 699 A.2d 434 (1997)(because State Open Meetings Act applies to “ ‘a special exception, variance, conditional use, zoning classification, the enforcement of any zoning law or regulation, or any other zoning matter,’ ” Court of Appeals rejected county’s argument that Act did not apply to its consideration of development or subdivision matters)(emphasis added and citation omitted); State Ins. Comm’r v. Nationwide Mut. Ins.

Co., 241 Md. 108, 115-16 , 215 A.2d 749 (1966)(al-though statute created tax credits for payments made for “ ‘any premium or income or other taxes, or any fees, fines, penalties, licenses, deposit requirements or other obligations, prohibitions or restrictions!’,]’ ” the phrase “other obligations” was not limited to the specific things in the words preceding it) (citation omitted); Belcher, 315 Md. at 121-22, 553 A.2d 691 (statute permitting homeowners to claim tax credit based on taxpayer’s gross income defined “gross income” as including “ ‘the net income received from business, rental, or other endeavors’ ”; income from “other endeavors” did not mean only operation of a “business” and did include income resulting from management of one’s own stock portfolio) (citation omitted). After considering these and other cases regarding the ejusdem, generis doctrine, and the purposes of section 14-126, we conclude that ejusdem generis should not be applied to limit the term “other relevant factors” to strict actuarial considerations. Most importantly, as we previously discussed, the Johns Hopkins Hosp. Court already has given a broader construction to the IC’s power, holding that the IC may consider State policies regarding health care set by other agencies as a “relevant factor” in disapproving and modifying rates.

Johns Hopkins Hosp. teaches us that the legislature did not intend that the enumerations in subsection (b)(3) would preclude the IC from considering State policy regarding health care that was not enumerated in those sections. Although ejusdem generis was not explicitly argued in Johns Hopkins Hosp., reasons for rejecting the doctrine are ⁴⁷⁰ readily apparent. First, if the General Assembly had intended that “other relevant factors” included only actuarial factors, it could easily have so stated by using the phrase, “other relevant actuarial factors.” Second, the four factors listed in subsection (b)(3)(ii) differ in character from the readily identifiable list of “things” or “persons” featured in many other instances when ejusdem generis has been applied. Cf., e.g., In re Wallace W., 333 Md. at 190-91 , 634 A.2d 53 (specific nouns itemized different livestock and vehicles).

The listed factors are not “concrete” “persons, places, or things” but rather general types of information. Nor is the list long or detailed enough to establish. that the legislature was attempting to restrict the IC to considering only “other relevant actuarial information.” Cf. Linkus, 114 Md.App. at 280-81 , 689 A.2d 1254 (list of 11 different findings that justified denial of license application, with no “catchall” category listed.) We found no cases that applied the doctrine to such a short list of generalized information.

III

Insurers’ Argument That HSCRC Has Exclusive Authority Nor are we persuaded by the insurers argument that the HSCRC’s authority to deny an insurer’s application for the SAAC differential when its SAAC rates are not affordable curtails the IC’s right to consider the SAAC differential in disapproving or modifying that insurer’s rate proposal. Two agencies may take action within the ambit of their own powers to accomplish the same objective. See Johns Hopkins Hosp., 302 Md. at 419-20 , 488 A.2d 942 . In disapproving the proposed rates, the IC acted strictly -within the confines of his authority to approve or disapprove rates of non-profit insurers, and did not encroach on the HSCRC’s authority to establish hospital rates in doing so.

We see no reason why the IC, acting within the scope of