17B:27A-10.6 Calculation of reinsurance payment.
155 words·~1 min read·
/nj/title-17b/chapter-27a/17b-27a-10-6·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
6. a. Each reinsurance payment shall be calculated with respect to an eligible carrier's paid claims for an individual enrollee's covered benefits in the applicable benefit year. If the paid claims do not exceed the attachment point, a reinsurance payment shall not be made. If the paid claims exceed the attachment point, the reinsurance payment shall be calculated as the product of the coinsurance rate and the lesser of:
(1)the paid claims minus the attachment point; or
(2)the reinsurance cap minus the attachment point.
b. The board shall ensure that reinsurance payments made to eligible carriers do not exceed the total amount paid by the eligible carrier for any eligible claim. "Total amount paid" means the amount paid by the eligible carrier based upon the allowed amount less any deductible, coinsurance, or co-payment, as of the time the data are submitted or made accessible under section 7 of this act.
L.2018, c.24, s.6.