220 R.I. Code R. 220-RICR-90-00-2.4

Current through December 26, 2024

Section 220-RICR-90-00-2.4 - Information Reporting

A. As a condition of receiving reinsurance payments from the program, a reinsurance eligible issuer must provide the following information to the program in the form and manner prescribed by the Director:

1. The name and company code assigned to the reinsurance eligible issuer by the National Association of Insurance Commissioners;

2. The identification number assigned to the reinsurance eligible issuer by the Health Insurance Oversight System (HIOS);

3. The total amount of the reinsurance eligible issuer's reinsurance eligible claims for the benefit year;

4. The portion of the reinsurance eligible issuer's total reinsurance eligible claims for the benefit year that fall between the attachment point and reinsurance cap;

5. A summary data file containing the following information for each reinsurance eligible individual with claims for which reinsurance payments are being requested:

a. An identification number assigned by the reinsurance eligible issuer to the reinsurance eligible individual;

b. The start and end dates of coverage for the reinsurance eligible individual;

c. The HIOS plan identification number for the reinsurance eligible health benefit plan in which the reinsurance eligible individual was enrolled;

d. The total amount of reinsurance eligible claims for the reinsurance eligible individual for the benefit year; and e. The total amount of reinsurance eligible claims for the reinsurance eligible individual for the benefit year that fall between the attachment point and reinsurance cap.

6. If requested by the Director, in conjunction with the final year-end report or an audit, a detailed claims file extracted from the reinsurance eligible issuer's claims processing system that includes the issuer's complete record of all reinsurance eligible claims for the benefit year.

7. An attestation signed by an executive officer of the reinsurance eligible issuer stating that the information is accurate as of the date of submission; and

8. Any other information requested by the Director that he or she deems necessary to administer the program.

B. As a condition of receiving reinsurance payments from the program, a reinsurance eligible issuer must submit the information required under § 2.4(A) of this Part to the program:

1. Using a secure method of transmission approved by the Director; and

2. On the following timeframes:

a. Upon request, one interim report during the benefit year for the purposes of estimating reinsurance payments;

b. One interim report due on February 15th after the benefit year, containing data from the prior benefit year with claims paid by January 31st, and an estimate of claims payments still outstanding. This report will be used to aid the Director in setting parameters for future program years; and

c. One final report due June 30th after the benefit year, containing all reinsurance eligible claims incurred during the prior benefit year and paid by June 1st for the purposes of calculating final reinsurance payments to carriers.

C. A reinsurance eligible issuer shall ensure that it is able to readily identify the reinsurance eligible individual associated with the identification number it assigns under § 2.4(A)(5)(a) of this Part and shall provide this identifying information to the Director upon request.

220 R.I. Code R. 220-RICR-90-00-2.4

Adopted effective 12/4/2019