As used in this part 11, unless the context otherwise
requires:
(1)Attachment point means the amount set by the commissioner pursuant
to section 10-16-1105 (2) for claims costs incurred by an eligible carrier for a
covered person's covered benefits in a benefit year, above which the claims costs
for benefits are eligible for reinsurance payments under the reinsurance program.
(2)Benefit year means the calendar year for which an eligible carrier
provides coverage through an individual health benefit plan.
(3)Coinsurance rate means the rate set by the commissioner pursuant to
section 10-16-1105 (2) at which the reinsurance program will reimburse an eligible
carrier for claims incurred for a covered person's covered benefits in a benefit year,
which claims exceed the attachment
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As used in this part 11, unless the context otherwise
requires:
(1) Attachment point means the amount set by the commissioner pursuant
to section 10-16-1105 (2) for claims costs incurred by an eligible carrier for a
covered person's covered benefits in a benefit year, above which the claims costs
for benefits are eligible for reinsurance payments under the reinsurance program.
(2) Benefit year means the calendar year for which an eligible carrier
provides coverage through an individual health benefit plan.
(3) Coinsurance rate means the rate set by the commissioner pursuant to
section 10-16-1105 (2) at which the reinsurance program will reimburse an eligible
carrier for claims incurred for a covered person's covered benefits in a benefit year,
which claims exceed the attachment point but are below the reinsurance cap.
(4) Commissioner means the commissioner of insurance, the
commissioner's deputies, or the division of insurance, as appropriate.
(5) Eligible carrier means a carrier that:
(a) Offers individual health benefit plans that comply with the federal act;
and
(b) Incurs claims costs for a covered person's covered benefits in the
applicable benefit year.
(6) Hospital means a hospital licensed or certified by the department of
public health and environment pursuant to section 25-1.5-103 (1)(a).
(7) Medicaid means federal insurance or assistance as provided by Title
XIX of the federal Social Security Act, as amended, and the Colorado Medical
Assistance Act, articles 4, 5, and 6 of title 25.5.
(8) Medicare means federal insurance or assistance provided by the
Health Insurance for the Aged Act, Title XVIII of the federal Social Security Act,
as amended, 42 U.S.C. sec. 1395 et seq.
(9) Payment parameters means the attachment point, reinsurance cap, and
coinsurance rate for the reinsurance program.
(10) Reinsurance cap means the amount set by the commissioner pursuant
to section 10-16-1105 (2) for claims costs incurred by an eligible carrier for a
covered person's covered benefits, above which amount the claims costs for
benefits are no longer eligible for reinsurance payments.
(11) Reinsurance payment means an amount paid to an eligible carrier
under the reinsurance program.
(12) Reinsurance program or program means the Colorado reinsurance
program established under section 10-16-1105.
(13) State innovation waiver means a waiver of one or more requirements of
the federal act authorized by section 1332 of the federal act, codified in 42 U.S.C.
sec. 18052, and applicable federal regulations.
Source: L. 2019: Entire part added, (HB 19-1168), ch. 204, p. 2177, � 1,
effective May 17.