16 Del. Admin. Code § 5001-6.0

Current through Register Vol. 28, No. 7, January 1, 2025

Section 5001-6.0 - Reinsurance Payments

6.1 A reinsurance eligible issuer becomes eligible for a reinsurance payment when the claims costs for at least one reinsurance eligible individual's covered benefits in a calendar year exceed the attachment point.

6.2 Under the intergovernmental agreement with CMS, the Executive Director receives from CMS reports detailing the reinsurance payments on a cumulative basis, to date, owed to each reinsurance eligible issuer.

6.2.1 Subject to subsections 6.2.2 and 6.2.3, the reinsurance payment made to each reinsurance eligible issuer for a benefit year will be the product of the coinsurance rate and the portion of the reinsurance eligible issuer's total reinsurance eligible claims for the benefit year that fall between the attachment point and the reinsurance cap.

6.2.2 The Executive Director shall uniformly reduce or increase the coinsurance rate to the extent necessary, but at no time shall the increase exceed 100%, to ensure that reinsurance payments do not exceed the total available funding for the benefit year, as determined by the Executive Director in his or her sole discretion.

6.3 The program shall issue reinsurance payments to all reinsurance eligible issuers on an annual basis in the year following each benefit year. The Executive Director shall issue a payment schedule to all issuers.

6.4 Payments shall be made directly to reinsurance eligible issuers by a method designated by the Executive Director.

6.5 If the Executive Director determines that a reinsurance eligible issuer has substantively failed to comply with this regulation, he or she shall give notice thereof to the issuer stating the Executive Director's findings and stating how the nonconformance can be remedied. The Executive Director shall specify a time period for remedying the nonconformance. The program shall not issue reinsurance payments until the nonconformance is remedied.

16 Del. Admin. Code § 5001-6.0

24 DE Reg. 1009( 5/1/2021) (final)