| | | 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 April | | 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 | | coverage is involuntarily terminated for any reason other than | | nonpayment of premium may apply for coverage under the plan.__If | | such coverage is applied for within 90 days after the involuntary | | termination and if premiums are paid for the entire period of | | coverage, the effective date of the coverage is the date of | | termination of the previous coverage. |
|
| | | 2.__Major medical expense coverage.__The plan must offer major | | medical expense coverage to every covered person who is not | | eligible for Medicare.__The board shall establish the coverage to | | be issued by the plan, its schedule of benefits and exclusions | | and other limitations, which the board may amend from time to | | time subject to the approval of the superintendent. In | | establishing the plan coverage, the board shall take into | | consideration the levels of health insurance provided in the | | State and medical economic factors as determined appropriate. |
|
| | | 3.__Rates. Rates for coverage issued by the association must | | meet the requirements of this subsection. |
|
| | | A.__Rates may not be unreasonable in relation to the | | benefits provided, the risk experience and the reasonable | | expenses of providing the coverage. |
|
| | | B.__Rate schedules must comply with section 2736-C and are | | subject to approval by the superintendent. |
|
| | | C.__Subject to approval by the superintendent, standard risk | | rates for coverage issued by the association must be established | | by the association using reasonable actuarial techniques and must | | reflect anticipated experiences and expenses of such coverage for | | standard risks. The premium for the standard risk rates must | | range from a minimum of 125% to a maximum of 150% of the weighted | | average of rates charged by those insurers and health maintenance |
|
|
