Current through Register Vol. 46, No. 39, September 25, 2024
(a) On or before May 1 of every year
following a plan year in which an adjustment was made pursuant to section
365.4, each insurer participating
in the family leave benefits market shall, pursuant to instructions issued by
the department, deposit into the COVID-19 Risk Adjustment Pool an amount equal
to the total amount of premium it collected that is attributable to the
adjustment made under section
365.4.
(b) On or before June 1 of every year
following a plan year in which an adjustment was made pursuant to section
365.4, the superintendent shall
disburse the moneys in the COVID-19 Risk Adjustment Pool collected pursuant to
subdivision (a), to those insurers who have made payments pursuant to
subdivision (a), in proportion to the actual claims experience of those
insurers related to COVID-19 claims. Provided, however, that:
(1) no disbursement shall be made to an
insurer that would render the total payments made to that insurer from this
mechanism greater than the amount it paid in COVID-19 claims;
(2) any disbursement that would be made to an
insurer who obtained an immediate relief payment under section
365.2 shall be reduced
proportionately based on the total amount of COVID-19 claims compared to the
total relief payments received and the funds subject to such reduction shall
instead:
(i) if the relief payment was funded
entirely by contributions of the State Insurance Fund, be disbursed to the
State Insurance Fund; or
(ii) if
the relief payment was not funded entirely by contributions of the State
Insurance Fund, be disbursed proportionately to each insurer that made a
contribution that funded the relief payment.
(3) any disbursement that would be made to an
insurer who obtained an immediate relief payment under section
365.2 that has failed to make
interest payments as required shall be withheld and the superintendent may
disburse the funds to cover the interest obligation of the insurer, provided
that if the amount withheld is greater than the remaining interest obligation
of the insurer, then excess funds shall be disbursed to all other insurers who
have made payments pursuant to subdivision (a), in proportion to the actual
claims experience of those insurers related to COVID-19 claims.
(c) Any funds remaining in the
COVID-19 Risk Adjustment Pool that were collected pursuant to subdivision (a)
of this section, after the application of the rules in subdivision (b) shall be
distributed to cover any remaining interest charge owed pursuant to an
immediate relief payment under section
365.2 by any member of the
COVID-19 Risk Adjustment mechanism or if no such charge exists, shall be
distributed in such other manner as the superintendent deems
appropriate.
(d) For the purposes
of this section the term insurer shall include the State Insurance Fund. The
term may also include self-insured employers in the discretion of the
superintendent, who shall render such a decision after reviewing the actual
COVID-19 claims experience for the entire market.
(e)
(1) No
insurer that received an immediate relief payment under this Part shall be
permitted to discontinue offering coverage for disability and family leave
benefits before the entire amount received has been recouped pursuant to this
section and the entire interest obligation has been repaid.
(2) Notwithstanding paragraph (1) of this
subdivision, an insurer who has, outside of the recoupment process described in
section 365.4 of this Part, paid to each
insurer that funded the relief payment it received an amount equal to the
relief payment and the total amount of interest required to be paid may request
to discontinue offering coverage for disability and family leave benefits in
accordance with subdivisions (l) and (m) of section
363.6, subject to such other
requirements as may be applicable.
(3) In the event that an insurer exits the
market for family leave benefits and the total amount of immediate relief
payments it received or any interest obligation it has related to such payments
has not been repaid such amounts shall be combined and treated as COVID-19
claims costs incurred by the insurer or insurers who funded the immediate
relief payment. Any interest obligation of the insurer shall thereafter be paid
by the exiting insurer into the COVID-19 Risk Adjustment Pool.
