(a)After each calendar year, the administrator shall
determine the pool net premiums which are premiums less
administrative expense allowances, the pool administrative
expenses and the pool incurred losses for the calendar year
considering investment income and other appropriate gains and
losses.
(b)Each insurer's assessment shall be determined by
multiplying the total cost of pool operation by a fraction the
numerator of which equals the insurer's premium and subscriber
contract charges for health insurance written in the state
during the preceding calendar year and the denominator of which
equals the total of all premiums, subscriber contract charges
written in the state and to the extent not preempted by federal
law, one hundred ten percent (110%) of all claims paid by
insurance arran
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(a) After each calendar year, the administrator shall
determine the pool net premiums which are premiums less
administrative expense allowances, the pool administrative
expenses and the pool incurred losses for the calendar year
considering investment income and other appropriate gains and
losses.
(b) Each insurer's assessment shall be determined by
multiplying the total cost of pool operation by a fraction the
numerator of which equals the insurer's premium and subscriber
contract charges for health insurance written in the state
during the preceding calendar year and the denominator of which
equals the total of all premiums, subscriber contract charges
written in the state and to the extent not preempted by federal
law, one hundred ten percent (110%) of all claims paid by
insurance arrangements in the state during the preceding
calendar year. To the extent not preempted by federal law, each
insurance arrangement's assessment shall be determined by
multiplying the total cost of pool operation by a fraction the
numerator of which equals one hundred ten percent (110%) of the
benefits paid by the insurance arrangement on behalf of insureds
in this state during the preceding calendar year and the
denominator of which equals the total of all premiums,
subscriber contract charges and one hundred ten percent (110%)
of all benefits paid by insurance arrangements made on behalf of
insureds in the state during the preceding calendar year. Health
insurance premiums and benefits paid by an insurance arrangement
that are less than an amount determined by the board to justify
the cost of collection shall not be considered for purposes of
determining assessments. To the extent not preempted by federal
law, insurance arrangements shall report to the board on an
annual basis on a form prescribed by the commissioner. Members
shall file with the board annual reports and other reports
deemed necessary by the board to determine each member's
proportion of participation.
(c) On or before March 1 of each year, the board shall
determine each member's proportion of participation in the pool
for the calendar year based on annual statements and other
reports deemed necessary by the board and filed by the member
with the board. Any deficit incurred by the pool shall be
recouped by assessments apportioned under subsection (b) of this
section by the board among members. Notification of assessments
shall be mailed by the board not later than March 1 of each
year. Assessments are due and payable within thirty (30) days
after receipt of the assessment notice.
(d) For the total amount of assessments due from all
members in any one (1) calendar year pursuant to this section up
to four million dollars ($4,000,000.00), eighty percent (80%) of
each member's proportionate contribution to the first two
million dollars ($2,000,000.00) and fifty percent (50%) of the
next two million dollars ($2,000,000.00) shall be allowed as a
credit against any premium tax owed by the member under this
code in the year for which the assessment is payable. The
board shall not make a total assessment against all members of
more than six million dollars ($6,000,000.00) in any one (1)
fiscal year. Assessments received shall be used to defray the
total cost of level one (1) pool operations first. Assessment
amounts not required to support level one (1) pool operations
will be used to support level two (2) operations before any
general fund appropriation is used. The general fund
appropriation shall only be used to support level two (2)
operations. The board shall ensure that all expenses directly
attributable to level one (1) individuals are paid from
premiums, assessments and any withdrawals from previous
reserves.
(e) The board may abate or defer, in whole or in part, the
assessment of a member if, in the opinion of the board, payment
of the assessment would endanger the ability of the member to
fulfill its contractual obligations. In the event an assessment
against a member is abated or deferred in whole or in part, the
amount by which the assessment is abated or deferred may be
assessed against the other members in a manner consistent with
the basis for assessments set forth in subsection (b) of this
section. The member receiving an abatement or deferment shall
remain liable to the pool for the deficiency for four (4) years.
(f) If assessments exceed actual losses and administrative
expenses of the pool, the excess shall be paid to the state
treasurer, credited to the account and used by the board to
offset future losses or to reduce pool premiums. As used in this
subsection, "future losses" includes reserves for incurred but
unreported claims.
(g) The board may require initial and interim assessments
as reasonable and necessary for the organizational,
administrative and interim operating expenses and to pay claims
in excess of premiums collected. Any initial or interim
assessments shall be credited as offsets against any regular
assessments due following the close of the calendar year.
(h) Assessments collected pursuant to this act shall be
paid to the state treasurer and credited to the account.