§ 27-18.5-9 - Affordable health plan reinsurance program for individuals. - Rhode Island Statutes

SECTION 27-18.5-9

   § 27-18.5-9  Affordable health planreinsurance program for individuals. – (a) The commissioner shall allocate funds from the affordable health planreinsurance fund for the affordable health reinsurance program.

   (b) The affordable health reinsurance program for individualsshall only be available to high-risk individuals as defined in §27-18.5-2, and who purchase the direct wellness health benefit plan pursuant tothe provisions of this section. Eligibility shall be determined based on stateand federal income tax filings.

   (c) The affordable health plan reinsurance shall be in theform of a carrier cost-sharing arrangement, which encourages carriers to offera discounted premium rate to participating individuals, and whereby thereinsurance fund subsidizes the carriers' losses within a prescribed corridorof risk as determined by regulation.

   (d) The specific structure of the reinsurance arrangementshall be defined by regulations promulgated by the commissioner.

   (e) The commissioner shall determine total eligibleenrollment under qualifying individual health insurance contracts by dividingthe funds available for distribution from the reinsurance fund by the estimatedper member annual cost of claims reimbursement from the reinsurance fund.

   (f) The commissioner shall suspend the enrollment of newindividuals under qualifying individual health insurance contracts if thedirector determines that the total enrollment reported under such contracts isprojected to exceed the total eligible enrollment, thereby resulting inanticipated annual expenditures from the reinsurance fund in excess ofninety-five percent (95%) of the total funds available for distribution fromthe fund.

   (g) The commissioner shall provide the health maintenanceorganization, health insurers and health plans with notification of anyenrollment suspensions as soon as practicable after receipt of all enrollmentdata.

   (h) The premiums of qualifying individual health insurancecontracts must be no more than ninety percent (90%) of theactuarially-determined and commissioner approved premium for this health planwithout the reinsurance program assistance.

   (i) The commissioner shall prepare periodic public reports inorder to facilitate evaluation and ensure orderly operation of the funds,including, but not limited to, an annual report of the affairs and operationsof the fund, containing an accounting of the administrative expenses charged tothe fund. Such reports shall be delivered to the co-chairs of the jointlegislative committee on health care oversight by March 1st of each year.