LD 1190
pg. 14
Page 13 of 18 An Act To Create the Comprehensive Health Insurance Risk Pool Association Page 15 of 18
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LR 436
Item 1

 
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 the provisions of this Title that
apply to similar insurance products.

 
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 governmental 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 any benefits paid to the
participant that should not have been claimed or recognized as
claims because of the provisions of this subsection or because
the benefits are otherwise not covered.__Benefits due from the
association may be reduced or refused as a setoff against any
amount recoverable under this subsection.


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