Sec. 21.55.220. Operation of the plan.

609 words·~3 min read·/ak/title-21/chapter-55/21-55-220

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)Upon notification of eligibility under AS 21.55.320 , a person may enroll in a state plan by payment of the appropriate state plan premium to the plan administrator.

(b)[Repealed, § 29 ch 30 SLA 2009.]

(c)Each member of the association shall share the losses due to claims expenses of the state plans issued or approved for issuance by the association; each member of the association shall share the losses of a reinsurance program established by regulations adopted under AS 21.55.400 reinsuring residents who are high risks; and each member of the association shall share in the operating and administrative expenses incurred or estimated to be incurred by the association incident to the conduct of its affairs. Claims expenses of the state plan that exceed the premium payments allocated to the payment of benefits shall be the liability of the members. Each member shall share in the claims expense of the state plans, the operating and administrative expenses of the association, and the losses of a reinsurance program established by regulations adopted under AS 21.55.400 reinsuring residents who are high risks, in an amount equal to the ratio of the member's total major medical premiums, received from or on behalf of state residents, as divided by the total major medical premiums received by all members from or on behalf of state residents, as determined by the director.

(d)The board shall make an annual determination of each member's liability, if any, and may make an annual fiscal year end assessment if necessary. The board may also provide for interim assessments against the members as may be necessary to assure the financial capability of the association in meeting the incurred or estimated claims expenses of the state plans and operating and administrative expenses of the association until the association's next annual fiscal year end assessment. Payment of an assessment is due within 30 days after receipt by a member of written notice of a fiscal year end or interim assessment. A member who fails to pay a fiscal year end or interim assessment as required in this subsection

(1)shall pay a civil penalty to the director in the amount of $100 for each day the member fails to pay the required assessment, and

(2)may have the member's certificate of authority revoked by the director. A member that ceases to do business in the state remains liable for assessments until the board determines under

(c)of this section that no assessment is due. The board may decline to levy an assessment against a member if the assessment would be minimal. Assessments paid by a member are a general expense of the member.

(e)Net gains, if any, from the operation of the state plans shall be held at interest and used by the association to offset future losses due to claims expenses of a state plan or allocated to reduce state plan premiums.

(f)A member may offset 50 percent of the amount of the assessment under this section as a premium tax credit reducing the premium tax payable by the member under AS 21.09.210 . The offset shall apply to the tax levied for the calendar year following an annual determination of each member's liability under

(d)of this section. The offset may not reduce the premium tax payable by a member to less than zero or create a premium tax credit for the member. An unused offset may be carried over to the immediately following calendar year. An offset made under this subsection is not subject to AS 21.09.270 .

Article 4. Enrollment in the State Health Insurance Plan.