§ 27-50-17. Affordable health plan reinsurance program for small businesses.
(a) The commissioner shall allocate funds from the affordable health plan reinsurance
fund for the affordable health reinsurance program.
(b) The affordable health reinsurance program for small businesses shall only be available
to low-wage firms, as defined in § 27-50-3, who pay a minimum of fifty percent (50%), as defined in § 27-50-3, of single coverage premiums for their eligible employees, and who purchase the wellness
health benefit plan pursuant to § 27-50-10. Eligibility shall be determined based on state and federal corporate tax filings.
All eligible employees, as defined in § 27-50-3, employed by low-wage firms as defined in § 27-50-3 shall be eligible for the reinsurance program if at least one low-wage eligible employee
as defined in regulation is enrolled in the employer's wellness health benefit plan.
(c) The affordable health plan reinsurance shall be in the firms of a carrier cost-sharing
arrangement, which encourages carriers to offer a discounted premium rate to participating
individuals, and whereby the reinsurance fund subsidizes the carriers' losses within
a prescribed corridor of risk as determined by regulation.
(d) The specific structure of the reinsurance arrangement shall be defined by regulations
promulgated by the commissioner.
(e) All carriers who or that participate in the Rhode Island RIte Care program as defined
in § 42-12.3-4 and the procurement process for the Rhode Island state employee account, as described
in chapter 12 of title 36, must participate in the affordable health plan reinsurance program.
(f) The commissioner shall determine total eligible enrollment under qualifying small
group health insurance contracts by dividing the funds available for distribution
from the reinsurance fund by the estimated per-member annual cost of claims reimbursement
from the reinsurance fund.
(g) The commissioner shall suspend the enrollment of new employers under qualifying small
group health insurance contracts if the director determines that the total enrollment
reported under such contracts is projected to exceed the total eligible enrollment,
thereby resulting in anticipated annual expenditures from the reinsurance fund in
excess of ninety-five percent (95%) of the total funds available for distribution
from the fund.
(h) In the event the available funds in the affordable health reinsurance fund as created
in § 42-14.5-3 are insufficient to satisfy all claims submitted to the fund in any calendar year,
those claims in excess of the available funds shall be due and payable in the succeeding
calendar year, or when sufficient funds become available, whichever shall first occur.
Unpaid claims from any prior year shall take precedence over new claims submitted
in any one year.
(i) The commissioner shall provide the health maintenance organization, health insurers,
and health plans with notification of any enrollment suspensions as soon as practicable
after receipt of all enrollment data. However, the suspension of issuance of qualifying
small group health insurance contracts shall not preclude the addition of new employees
of an employer already covered under such a contract or new dependents of employees
already covered under such contracts.
(j) The premiums of qualifying small group health insurance contracts must be no more
than ninety percent (90%) of the actuarially-determined and commissioner approved
premium for this health plan without the reinsurance program assistance.
(k) The commissioner shall prepare periodic public reports in order to facilitate evaluation
and ensure orderly operation of the funds, including, but not limited to, an annual
report of the affairs and operations of the fund, containing an accounting of the
administrative expenses charged to the fund. The reports shall be delivered to the
co-chairs of the joint legislative committee on health care oversight by March 1 of
each year.