§ 15-1218
318 words·~1 min read·
/md/insurance/15-1218A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–1218.
(a)A reinsuring carrier may reinsure with the Pool as provided in this section.
(b)At a minimum, the Pool shall reinsure up to the level of coverage specified under the Standard Plan.
(c)A reinsuring carrier may reinsure an entire employer group within 60 days after commencement of the group’s coverage under a health benefit plan.
(1)A reinsuring carrier may reinsure an eligible employee or dependent within 60 days after commencement of coverage with the small employer.
(2)A reinsuring carrier may reinsure a newly eligible employee or dependent within 60 days after commencement of coverage of the eligible employee or dependent.
(1)The Pool may not reimburse a reinsuring carrier with respect to the claims of an individual until the reinsuring carrier has incurred claims for the individual of $5,000 in a calendar year for benefits covered by the Pool.
(2)After the initial $5,000 of incurred claims, the reinsuring carrier is responsible for 10% of the next $50,000 of incurred claims during the calendar year, and the Pool shall reinsure the remainder.
(3)The liability of a reinsuring carrier under this subsection may not exceed $10,000 in any 1 calendar year with respect to any individual.
(1)The Board annually shall adjust the initial level of claims and the maximum limit to be retained by the reinsuring carrier to reflect increases in costs and utilization within the standard market for health benefit plans in the State.
(2)Unless the Board proposes and the Commissioner approves a lower adjustment factor, the adjustment in paragraph
(1)of this subsection may not be less than the annual change in the medical component of the “Consumer Price Index for all Urban Consumers” of the Department of Labor, Bureau of Labor Statistics.
(g)A reinsuring carrier may terminate reinsurance on a plan anniversary for one or more of the individuals in a small employer group.