LD 1945
pg. 13
Page 12 of 18 An Act To Establish a High-risk Health Insurance Pool Page 14 of 18
Download Bill Text
LR 2814
Item 1

 
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. The requirements of this plan become
effective January 1, 2007.__Policies offered through the
association must be available for sale beginning on January 1,
2008. The association shall directly insure the coverage provided
by the plan, and the policies must be issued through the plan
administrator.__At least one coverage option must be a
standardized health plan as defined in Chapter 750 of the rules
of the bureau.

 
§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 an eligible person is also eligible for
Medicare coverage, the plan may not pay or reimburse any person
for expenses paid by Medicare.__Any person whose health insurance
coverage is involuntarily terminated for any reason other than
nonpayment of premiums 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 eligible person who is not
eligible for Medicare.__The coverage to be issued by the plan,
its schedule of benefits and exclusions and other limitations
must be established by the board and may be amended 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 and 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


Page 12 of 18 Top of Page Page 14 of 18