LD 1190
pg. 13
Page 12 of 18 An Act To Create the Comprehensive Health Insurance Risk Pool Association Page 14 of 18
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LR 436
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 April 1, 2003.__Policies offered through the
association must be available for sale August 1, 2003. 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 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 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 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 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.


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