§ 27-50-17 - Affordable health plan reinsurance program for small businesses.
SECTION 27-50-17
§ 27-50-17 Affordable health planreinsurance program for small businesses. – (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 smallbusinesses shall only be available to low wage firms, as defined in §27-50-3, who pay a minimum of fifty percent (50%), as defined in §27-50-3, of single coverage premiums for their eligible employees, and whopurchase the wellness health benefit plan pursuant to § 27-50-10.Eligibility shall be determined based on state and federal corporate taxfilings. All eligible employees, as defined in § 27-50-3, employed by lowwage firms as defined in § 27-50-3-(oo) shall be eligible for thereinsurance program if at least one low wage eligible employee as defined inregulation is enrolled in the employer's wellness health benefit plan.
(c) The affordable health plan reinsurance shall be in thefirms 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) All carriers who participate in the Rhode Island RIteCare program as defined in § 42-12.3-4 and the procurement process for theRhode Island state employee account, as described in chapter 36-12, mustparticipate in the affordable health plan reinsurance program.
(f) The commissioner shall determine total eligibleenrollment under qualifying small group 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.
(g) The commissioner shall suspend the enrollment of newemployers under qualifying small group 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.
(h) In the event the available funds in the affordable healthreinsurance fund as created in § 42-14.5-3 are insufficient to satisfy allclaims submitted to the fund in any calendar year, those claims in excess ofthe available funds shall be due and payable in the succeeding calendar year,or when sufficient funds become available whichever shall first occur. Unpaidclaims from any prior year shall take precedence over new claims submitted inany one year.
(i) 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. However, the suspension of issuance of qualifying small group healthinsurance contracts shall not preclude the addition of new employees of anemployer already covered under such a contract or new dependents of employeesalready covered under such contracts.
(j) The premiums of qualifying small group 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.
(k) 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.