LD 1945
pg. 14
Page 13 of 18 An Act To Establish a High-risk Health Insurance Pool Page 15 of 18
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LR 2814
Item 1

 
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.__Standard risk rates for coverage issued by the
association must be established by the association, subject
to approval by the superintendent, 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 organizations with individuals enrolled in
similar medical insurance plans.

 
4.__Compliance with state law.__Products offered by the
association must comply with all relevant requirements of this
Title applicable to individual health insurance policies,
including requirements for mandated coverage for specific health
services, for specific diseases and for certain providers of
health care services.

 
5.__Other sources primary. The association must be payer of
last resort of benefits whenever any other benefit or source of
3rd-party payment is available.__The coverage provided by the
association must be considered excess coverage, and benefits
otherwise payable under association coverage must be reduced by
all amounts paid or payable through any other health insurance
and by all hospital and medical expense benefits paid or payable
under any short-term, accident, dental-only, vision-only, fixed
indemnity, limited benefit or credit insurance; coverage issued
as a supplement to liability insurance; workers' compensation
coverage; automobile medical payment; or liability insurance
whether or not provided on the basis of fault, and by any
hospital or medical benefits paid or payable by any insurer or
insurance arrangement or any hospital or medical benefits paid or
payable under or provided pursuant to any state or federal law or
program.

 
6.__Recovery of claims paid.__An amount paid or payable by
Medicare or any other government program or any other insurance,
or self-insurance maintained in lieu of otherwise statutorily
required insurance, may not be made or recognized as claims under
such a policy or be recognized as or towards satisfaction of
applicable deductibles or out-of-pocket maximums or to reduce the
limits of benefits available.__The association has a cause of
action against a participant for the recovery of the amount of


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