§ 58-93-80. Incurred but not reported claims.
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§ 58-93-80. Incurred but not reported claims.
(a)Every PHP shall, when determining liability, include an amount estimated in the aggregate to provide for
(i)any unearned capitation payment,
(ii)the payment of all claims for health care expenditures that have been incurred, whether reported or unreported, that are unpaid and for which the PHP is or may be liable, and
(iii)the expense of adjustment or settlement of these claims.
(b)Liabilities shall be computed in accordance with rules adopted by the Commissioner based upon rules applicable to health maintenance organizations adjusted for reasonable consideration of the ascertained experience and character of the PHP. (2018-49, s. 1(a).)