Section 3 AAC 31.515 - Health care insurer eligibility for reinsurance payments(a) A health care insurer is eligible for reinsurance payments to reimburse the insurer for the claims of a high risk resident for a benefit year if the health care insurer (1) provides evidence to the association that the health care insurer has paid a claim of a high risk resident for the applicable benefit year that is for a covered condition listed under 3 AAC 3 1.540;(2) continues to pay the claims of a high risk resident for the applicable benefit year; (3) pays to the association, under (b) of this section, the premium amount the health care insurer receives under the insurance policy for the applicable benefit year covering the eligible high risk resident;(4) pays to the association, under (c) of this section, pharmacy rebates the health care insurer receives for the applicable benefit year for health care services provided to the applicable high risk resident; and(5) reports to the association payments, applicable to the high risk resident, the health care insurer collects for (A) third party liabilities; (B) payments the health care insurer recovers for overpayments;(C) payments for commercial reinsurance recoveries; and(D) estimated federal cost-sharing reduction payments made under 42 U.S.C. 18071.(b) The health care insurer shall pay to the association the separately identifiable premium amount the health care insurer received under the insurance policy for the applicable benefit year covering the eligible high risk resident on a quarterly basis not later than the dates set by the association and specified in the association's plan of operation after the association accepts a risk ceded to it with respect to a high risk resident. If the high risk resident has a separately identifiable premium equal to $0, the health care insurer shall pay to the association the highest separately identifiable premium under the family policy. For each additional high risk resident covered under a family policy who has a separately identifiable premium equal to $0, the health care insurer shall pay to the association the next highest separately identifiable premium under the family policy.(c) A health care insurer shall pay to the association a pharmacy rebate required to be paid to the association under (a)(4) of this section on a quarterly basis in conjunction with the payment of premiums under (b) of this section.Eff. 2/2/2013, Register 205; am 12/22/2016, Register 220, January 2017; am 11/1/2018,Register 228, January 2019Authority:AS 21.06.090
AS 21.55.220
AS 21.55.400