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Current as of January 01, 2024 | Updated by FindLaw Staff
a. Each reinsurance payment shall be calculated with respect to an eligible carrier's paid claims for an individual enrollee's covered benefits in the applicable benefit year. If the paid claims do not exceed the attachment point, a reinsurance payment shall not be made. If the paid claims exceed the attachment point, the reinsurance payment shall be calculated as the product of the coinsurance rate and the lesser of:
(1) the paid claims minus the attachment point; or
(2) the reinsurance cap minus the attachment point.
b. The board shall ensure that reinsurance payments made to eligible carriers do not exceed the total amount paid by the eligible carrier for any eligible claim. “Total amount paid” means the amount paid by the eligible carrier based upon the allowed amount less any deductible, coinsurance, or co-payment, as of the time the data are submitted or made accessible under section 7 of this act. 1
Cite this article: FindLaw.com - New Jersey Statutes Title 17B. Insurance 17B § 27A-10.6 - last updated January 01, 2024 | https://codes.findlaw.com/nj/title-17b-insurance/nj-st-sect-17b-27a-10-6/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
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