33-22-1315. Calculation of reinsurance payments. (1) Each reinsurance payment must be calculated with respect to an eligible health insurer's incurred claims costs for an individual enrollee's covered benefits in the applicable benefit year. If the claims costs do not exceed the attachment point, the reinsurance payment is $0. If the claims costs exceed the attachment point, the reinsurance payment must be calculated as the product of the coinsurance rate and the less of:
(a) the claims costs minus the attachment point; or
(b) the reinsurance cap minus the attachment point.
(2) The board shall ensure that the reinsurance payments made to the eligible health insurer do not exceed the total amount paid by the eligible health insurer for any eligible claim.
(3) For purposes of this section, "total amount paid" means the amount paid by the eligible health insurer based on the allowed amount less any deductible, coinsurance, or copayment.
History: En. Sec. 10, Ch. 210, L. 2019.
Structure Montana Code Annotated
Title 33. Insurance and Insurance Companies
Chapter 22. Disability Insurance
Part 13. Montana Reinsurance Association Act
33-22-1301. Short title -- purpose
33-22-1302. Reinsurance association -- mandatory membership -- exceptions
33-22-1304. and 33-22-1305 reserved
33-22-1306. Association board of directors
33-22-1307. Duties of commissioner -- rulemaking
33-22-1308. Board duties -- powers
33-22-1309. Association administrator
33-22-1310. through 33-22-1312 reserved
33-22-1313. Association member assessments
33-22-1314. Payment parameters
33-22-1315. Calculation of reinsurance payments
33-22-1316. Administration of reinsurance payments
33-22-1317. Eligible health insurer requests for reinsurance payments
33-22-1318. and 33-22-1319 reserved
33-22-1320. Liability of association members
33-22-1321. State and federal special revenue accounts -- reinsurance program