Montana Code 33-22-1314. Payment parameters
33-22-1314. Payment parameters. (1) The board shall design and adjust the payment parameters to ensure that the payment parameters will:
Terms Used In Montana Code 33-22-1314
- Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
- Board: means the association's board of directors provided for in 33-22-1306. See Montana Code 33-22-1303
- Coinsurance rate: means the rate at which the association will reimburse an eligible health insurer for claims incurred for an enrolled individual's covered benefits in a benefit year above the attachment point and below the reinsurance cap. See Montana Code 33-22-1303
- Individual market: means the market for health insurance coverage offered to individuals other than in connection with group health insurance coverage. See Montana Code 33-22-140
- Payment parameters: means the attachment point, reinsurance cap, and coinsurance rate for the Montana reinsurance program. See Montana Code 33-22-1303
- Reinsurance cap: means the maximum amount of each claim incurred by an eligible health insurer for an enrolled individual's covered benefits in a benefit year, after which the claims costs for benefits are no longer eligible for reinsurance payments. See Montana Code 33-22-1303
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Montana Code 1-1-201
(a)stabilize or reduce premium rates in the individual market;
(b)increase or maintain participation in the individual market;
(c)mitigate the impact high-cost individuals have on premium rates in the individual market;
(d)consider any federal funding available for the plan; and
(e)consider the total amount available to fund the plan.
(2)The attachment point must be set by the board at $40,000 or more but may not exceed the reinsurance cap.
(3)The coinsurance rate must be set by the board between 50% and 80%.
(4)The reinsurance cap must be set by the board at $1 million or less.
(5)The board may adjust the payment parameters annually to the extent necessary to secure federal approval of the state innovation waiver.