Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 857 - Small Business Health Insurance Premium Support Program
Section 031-857-5 - Reimbursement of Premium Relief Credits and Administrative Costs

Universal Citation: 02 ME Code Rules ยง 031-857-5

Current through 2024-38, September 18, 2024

1. Based on the information provided in Section 8, the program shall reimburse small group health insurance carriers for all premium relief credits provided to policyholders in accordance with this rule.

A. Reimbursement amounts shall be subject to adjustment if it is subsequently determined that credits were inaccurately reported or erroneously granted or denied, or if subsequent changes to the underlying premium bills result in changes to the applicable credits. Overpayments or underpayments of reimbursements shall be charged or credited as offsets in a subsequent reimbursement, and if necessary, a final reconciliation payment shall be made to the carrier or collected from the carrier after the end of the program.

B. Eligibility for reimbursement of a premium relief credit shall be based on whether the carrier provided coverage during that month to the employee and beneficiaries, and the employer owed premium for that coverage to the carrier, regardless of whether the premium owed was ultimately collected. No credit shall be reimbursed for months entirely preceding the inception date of the employee's coverage or entirely following the termination date of the employee's coverage.

2. In order to ensure that costs associated with providing the premium relief credits do not result in premium increases, the program shall provide small group health insurance carriers with payments intended to offset the reasonable administrative costs of providing this premium relief. Specific terms will be established through a written agreement between the Superintendent and each small group health insurance carrier. These reimbursements will include payment for the carrier's initial systems set-up for the program and its ongoing costs of administration and reporting for the program.

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