LD 394
pg. 15
Page 14 of 21 An Act To Create a High-risk Pool in the Health Insurance Market Page 16 of 21
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LR 516
Item 1

 
3.__Determination of assessment.__The board shall make
reasonable efforts to ensure that each covered person is counted
only once with respect to an assessment.__For that purpose, the
board shall require each insurer that obtains excess or stop loss
insurance to include in its count of covered persons all
individuals whose coverage is insured, in whole or in part,
through excess or stop loss coverage.__The board shall allow a
reinsurer to exclude from its number of covered persons those who
have been counted by the primary insurer or by the primary
reinsurer or primary excess or stop loss insurer for the purpose
of determining its assessment under this subsection.__The board
may verify each insurer's assessment based on annual statements
and other reports determined to be necessary by the board.__The
board may use any reasonable method of estimating the number of
covered persons of an insurer if the specific number is unknown.

 
4.__Excess funds.__If assessments and other receipts by the
association, board or plan administrator exceed the actual losses
and administrative expenses of the plan, the board shall hold the
excess as interest and may use those excess funds to offset
future losses or to reduce plan premiums. As used in this
subsection, "future losses" includes reserves for claims incurred
but not reported.

 
5.__Failure to pay assessment.__The superintendent may suspend
or revoke, after notice and hearing, the certificate of authority
to transact insurance in this State of any member insurer that
fails to pay an assessment.__As an alternative, the
superintendent may levy a penalty on any member insurer that
fails to pay an assessment when due.__In addition, the
superintendent may use any power granted to the superintendent by
this Title to collect any unpaid assessment.

 
§3909.__Availability of coverage

 
The association shall offer a choice of 2 or more coverage
options through the plan as set out in section 3910, subsections
1 and 2. The plan becomes effective October 1, 2005.__Policies
offered through the association must be available for sale
February 1, 2006.__The association shall directly insure the
coverage provided by the plan, and the policies must be issued
through the plan administrator.

 
§3910.__Requirements for coverage

 
1.__Coverage offered. The plan must offer in an annually
renewable policy the coverage specified in this section for each
eligible person. If a covered person is also eligible for
Medicare coverage, the plan may not pay or reimburse any person
for expenses paid by Medicare.__A person whose health insurance


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