§4334. Substantial insurance risk; substantial enrollment risk
1. Substantial insurance risk. Substantial insurance risk is risk based on the use or costs of referral services only, when the downstream entity is at risk for more than 25% of potential payments by the carrier to the downstream entity.
[PL 1999, c. 609, §20 (NEW).]
2. Substantial enrollment risk. Substantial enrollment risk exists when a carrier enters into a risk arrangement with a downstream entity involving more than 25% of the enrollees served by the carrier in the State unless the risk arrangement is a risk-sharing arrangement.
[PL 1999, c. 609, §20 (NEW).]
SECTION HISTORY
PL 1999, c. 609, §20 (NEW).
Structure Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT
24-A §4332. Safe harbor and waiver
24-A §4333. Requirements for downstream risk arrangements
24-A §4334. Substantial insurance risk; substantial enrollment risk
24-A §4335. Contractual provisions
24-A §4336. Disclosure requirements for organizations with downstream risk arrangements
24-A §4337. Requirements related to subcontracting arrangements
24-A §4338. Downstream risk arrangements that exceed risk threshold described in section 4334
24-A §4339. Contractual provisions to demonstrate financial viability
24-A §4340. Financial viability
24-A §4341. Limitations on premium transfer