South Carolina Code 38-71-1380. Notification of intent to operate; certain reinsuring insurers not permitted to continue to reinsure health insurance plan
(2) The decision shall be binding for a five-year period except that the initial decision shall be binding for two years. The director may permit an insurer to modify its decision at any time for good cause shown.
Terms Used In South Carolina Code 38-71-1380
- Director: means the Director of the Department of Insurance of this State. See South Carolina Code 38-71-1330
- insurance: includes annuities. See South Carolina Code 38-1-20
- Insurer: means an entity that provides health insurance in this State. See South Carolina Code 38-71-1330
- plan: means any hospital or medical policy or certificate, major medical expense insurance, hospital or medical service plan contract, or health maintenance organization subscriber contract that provides benefits consisting of medical care provided directly through insurance or reimbursement, or otherwise and including items and services paid for medical care. See South Carolina Code 38-71-1330
- Program: means the South Carolina Small Employer Insurer Reinsurance Program pursuant to § 38-71-1410. See South Carolina Code 38-71-1330
- Reinsuring insurer: means a small employer insurer participating in the reinsurance program pursuant to § 38-71-1410. See South Carolina Code 38-71-1330
- Risk-assuming insurer: means a small employer insurer whose application is approved by the commissioner pursuant to § 38-71-1390. See South Carolina Code 38-71-1330
- Small employer: means , in connection with a health insurance plan with respect to a calendar year and a plan year, any person, firm, corporation, partnership, association, or employer, as defined in Section 3(5) of the Employee Retirement Income Security Act of 1974, that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar year, employed no more than fifty eligible employees or employed an average of not more than fifty employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. See South Carolina Code 38-71-1330
- Small employer insurer: means an insurer that offers health insurance plans covering eligible employees of one or more small employers in this State. See South Carolina Code 38-71-1330
(3) The director shall establish an application process for small employer insurers seeking to change their status under this subsection. In the case of a small employer insurer that has been acquired by another such insurer, the director may waive or modify the time periods established in item (2).
(B) A reinsuring insurer that applies and is approved to operate as a risk-assuming insurer shall not be permitted to continue to reinsure any health insurance plan with the program. Such an insurer shall pay a prorated assessment based upon business issued as a reinsuring insurer for any portion of the year that the business was reinsured.