33-22-1314. Payment parameters.
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/mt/title-33/chapter-22/part-13/33-22-1314·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
33-22-1314 . Payment parameters.
(1)The board shall design and adjust the payment parameters to ensure that the payment parameters will:
(a)stabilize or reduce premium rates in the individual market;
(b)increase or maintain participation in the individual market;
(c)mitigate the impact high-cost individuals have on premium rates in the individual market;
(d)consider any federal funding available for the plan; and
(e)consider the total amount available to fund the plan.
(2)The attachment point must be set by the board at $40,000 or more but may not exceed the reinsurance cap.
(3)The coinsurance rate must be set by the board between 50% and 80%.
(4)The reinsurance cap must be set by the board at $1 million or less.
(5)The board may adjust the payment parameters annually to the extent necessary to secure federal approval of the state innovation waiver.