33-22-1315. Calculation of reinsurance payments.
151 words·~1 min read·
/mt/title-33/chapter-22/part-13/33-22-1315·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
33-22-1315 . Calculation of reinsurance payments.
(1)Each reinsurance payment must be calculated with respect to an eligible health insurer's incurred claims costs for an individual enrollee's covered benefits in the applicable benefit year. If the claims costs do not exceed the attachment point, the reinsurance payment is $0. If the claims costs exceed the attachment point, the reinsurance payment must be calculated as the product of the coinsurance rate and the less of:
(a)the claims costs minus the attachment point; or
(b)the reinsurance cap minus the attachment point.
(2)The board shall ensure that the reinsurance payments made to the eligible health insurer do not exceed the total amount paid by the eligible health insurer for any eligible claim.
(3)For purposes of this section, "total amount paid" means the amount paid by the eligible health insurer based on the allowed amount less any deductible, coinsurance, or copayment.