Maine Revised Statutes Title 24-A Sec. 4341 – Limitations on premium transfer
Current as of: 2023 | Check for updates
|
Other versions
The superintendent may deny a request for waiver based on any of the following characteristics: [PL 1999, c. 609, §20 (NEW).]
1. Transfer of 30% of annual aggregate premium. A contract by which 30% or more of the carrier‘s annual aggregate premium with respect to a contract, plan or product is transferred to a single downstream entity. This transfer is the sum of capitated payments plus the sum of amounts returnable to the carrier through incentive payments or other risk adjustments; or
[PL 1999, c. 609, §20 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4341
- Carrier: means :
A. See Maine Revised Statutes Title 24-A Sec. 4301-AContract: A legal written agreement that becomes binding when signed. Downstream entity: means a person other than a carrier that has assumed all or part of the insurance risk of one or more health plans under a contractual relationship with a carrier or another downstream entity. See Maine Revised Statutes Title 24-A Sec. 4331 Payments: means any amounts the carrier pays the downstream entity for services the downstream entity furnishes directly, plus amounts paid for administration and amounts paid in whole or in part based on use and costs of referral services such as withhold amounts, bonuses based on referral levels and any other compensation to the downstream entity to influence the use of referral services. See Maine Revised Statutes Title 24-A Sec. 4331
2. Transfer of 75% of annual aggregate premium. Multiple contracts by which 75% or more of the carrier’s annual aggregate premium with respect to a contract, plan or product is transferred to one or more downstream entities. This transfer is the sum of capitated payments plus the sum of amounts returnable to the carrier through incentive payments or other risk adjustments.
[PL 1999, c. 609, §20 (NEW).]
SECTION HISTORY
PL 1999, c. 609, §20 (NEW).