LD 394
pg. 16
Page 15 of 21 An Act To Create a High-risk Pool in the Health Insurance Market Page 17 of 21
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LR 516
Item 1

 
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 covered person who is not
eligible for Medicare.__The board shall establish the coverage to
be issued by the plan, its schedule of benefits and exclusions
and other limitations, which the board may amend 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.

 
B.__Rate schedules must comply with section 2736-C and are
subject to approval by the superintendent.

 
C.__Subject to approval by the superintendent, standard risk
rates for coverage issued by the association must be
established by the association 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, including
requirements for mandated coverage for specific health care
services and 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


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