(A) Any small employer insurer may elect to become a risk-assuming insurer upon application to and approval by the director. A small employer insurer shall not be approved as a risk-assuming insurer if the director finds that the insurer is not capable of assuming that status pursuant to the criteria set forth in subsection (B) of this section. The insurer shall provide public notice of its application to become a risk-assuming insurer. A small employer insurer’s application to be a risk-assuming insurer shall be approved unless disapproved by the director within sixty days after the insurer’s application. A small employer insurer that has had its application to be a risk-assuming insurer disapproved may request and shall be granted a public hearing within sixty days after the disapproval.

(B) In determining whether or not to approve an application by a small employer insurer to become a risk-assuming insurer, the director shall consider the insurer’s financial condition and the financial condition of its parent or guaranteeing corporation, if any; its history of assuming and managing risk; its ability to assume and manage the risk of enrolling small employers without the protection of the reinsurance provided in § 38-71-1410; and its commitment to fairly market to all small employers.

Terms Used In South Carolina Code 38-71-1390

  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Director: means the Director of the Department of Insurance of this State. See South Carolina Code 38-71-1330
  • Insurer: means an entity that provides health insurance in this State. 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
  Previous section
Next section  
 Article 13 Contents