NRS689C.800. Amount of coverage to be reinsured; time within which reinsurance may begin; limitation on reimbursement to reinsuring carrier; termination of reinsurance; premium rate charged to federally qualified health maintenance organization; manner of handling managed care and claims by reinsuring carrier. [Effective through December 31, 2013.]

      1.  The Program of Reinsurance must reinsure:

      (a) For a basic or standard health benefit plan, the level of coverage provided; and

      (b) For any other plan, up to the level of coverage provided in a basic or standard health benefit plan.

      2.  A reinsuring carrier may reinsure a small employer within 60 days after the beginning of coverage of the small employer under a health benefit plan, or for an eligible employee or a dependent of the eligible employee, within 60 days after the beginning of coverage of the employee or dependent under a health benefit plan. An individual reinsuring carrier may reinsure an eligible person or a dependent of the eligible person within 60 days after the effective date of coverage of the person or dependent under a health benefit plan.

      3.  The Program of Reinsurance may not reimburse a reinsuring carrier or an individual reinsuring carrier for a claim of a reinsured eligible employee or eligible person, or a dependent of such an employee or person, as appropriate, until the reinsuring or individual reinsuring carrier has incurred in a calendar year the minimum amount of claims of the eligible employee, eligible person or dependent of benefits covered by the Program of Reinsurance. After the amount of claims of the eligible employee, eligible person or dependent is equal to or greater than the required minimum amount, the reinsuring or individual reinsuring carrier is liable for 10 percent of the next $50,000 of payments of benefits that are paid during that calendar year and the Program of Reinsurance must reinsure the remainder of the benefit payments. The total liability of a carrier in a calendar year pursuant to this subsection may not exceed the maximum liability established by the Board.

      4.  For the purposes of subsection 3, the Board shall establish:

      (a) The minimum amount of claims, which must be in an amount that is equal to or greater than $5,000, that must be incurred before the Program of Reinsurance will reimburse the reinsuring or individual reinsuring carrier.

      (b) The maximum liability of a reinsuring or individual reinsuring carrier, which must be in an amount that is equal to or greater than $10,000.

Ê The Board shall annually adjust the minimum amount of claims and the maximum liability of a reinsuring or individual reinsuring carrier to reflect increases in the costs and utilization within the standard market for health benefit plans within this state. Unless the Board proposes and the Commissioner approves a factor that would provide for a lower adjustment, the adjustments must not be less than the annual change in the component for medical care of the Consumer Price Index for All Urban Consumers of the United States Department of Labor, Bureau of Labor Statistics.

      5.  A reinsuring carrier that provides health insurance coverage to small employers may terminate reinsurance with the Program of Reinsurance for a reinsured employee or dependent, and an individual reinsuring carrier may terminate reinsurance with the Program of Reinsurance for an eligible person or dependent, on the anniversary date of the health benefit plan.

      6.  The premium rates charged for reinsurance by the Program of Reinsurance to a health maintenance organization that is federally qualified pursuant to 42 U.S.C. §§ 300 et seq. and is subject to requirements limiting the amount of risk that may be ceded to a Program of Reinsurance that are more restrictive than the amounts set forth in subsection 5 must be reduced to reflect that portion of the risk above the amount determined pursuant to this section, if any, that may not be ceded to the Program of Reinsurance.

      7.  A reinsuring carrier or an individual reinsuring carrier purchasing reinsurance pursuant to this chapter or NRS 689A.470 to 689A.740, inclusive, shall apply its techniques for handling managed care and claims, including utilization review, individual case management, preferred provider provisions and other provisions or methods of operating relating to managed care, to the health benefit plans that are being reinsured pursuant to the Program of Reinsurance in a manner that is consistent with the business of the carrier that is not reinsured.

      8.  Nothing in this section prohibits a reinsuring carrier or an individual reinsuring carrier from terminating the coverage of a small employer or an eligible person on the grounds described in paragraph (c) of subsection 1 of NRS 687B.320.

      9.  The plan of operation must provide that:

      (a) A reinsuring carrier may reinsure a small employer or an eligible employee or a dependent of the eligible employee if coverage is written on or after July 1, 1997; and

      (b) An individual reinsuring carrier may reinsure an eligible person or a dependent of the eligible employee if coverage is written on or after January 1, 1998.

      (Added to NRS by 1997, 2932; R 2013, 3661, effective January 1, 2014)