Section 59A-54-16 – Pool policy.
A. A pool policy offered under the Medical Insurance Pool Act shall contain provisions under which the pool is obligated to renew the contract until the day on which the individual in whose name the contract is issued first becomes eligible for medicare coverage, except that in a family policy covering both husband and wife, […]
Section 59A-54-17 – Rules.
The superintendent shall: A. adopt rules that provide for disclosure by members of the pool of the availability of insurance coverage from the pool; B. adopt rules that implement the provisions of the Medical Insurance Pool Act; and C. adopt any other rules deemed necessary in order to carry out the provisions of the Medical […]
Section 59A-54-18 – Collective action.
Neither the participation by insurers in the pool, the establishment of rates, forms or procedures for coverages issued by the pool nor any other joint or collective action required by the Medical Insurance Pool Act shall be the basis of any legal action, civil or criminal liability or penalty against the members of the pool […]
Section 59A-54-19 – Rates; standard risk rate.
A. The pool shall determine a standard risk rate by actuarially calculating the individual rate that an insurer would charge for an individual policy with the pool benefits issued to a person who was a standard risk. Separate schedules of standard risk rates based on age and other appropriate demographic characteristics may be used. In […]
Section 59A-54-20 – Benefit payments reduction.
A. The pool shall be the last payer of benefits whenever any other benefit is available. Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance or health benefit plan, including a self-insured plan and by all hospital and medical expense benefits paid or payable […]
Section 59A-54-21 – Exemption.
The pool is exempt from payment of all fees and all taxes levied by this state or any of its political subdivisions. History: 1978 Comp., § 59A-54-21, enacted by Laws 1987, ch. 154, § 21.
Section 59A-54-15 – Dependent family member required coverage; employer responsibilities.
A. An employer is authorized to make a payroll deduction from the compensation of an employee for the portion of the pool policy premium the employee is responsible for, and an employer shall contribute the same dollar amount of the cost of that policy on behalf of the employee that the employer contributes for other […]
Section 59A-54-7 – Board; powers and duties.
The board shall have the general powers and authority granted under the laws of this state to insurance companies licensed to transact health insurance business. In addition, the board shall have the specific authority to: A. enter into contracts as are necessary or proper to carry out the provisions and purposes of the Medical Insurance […]
Section 59A-54-7.1 – Prescription drug program; cost-sharing.
A. The board may establish a prescription drug program, in whole or in part, including a pilot or phase-in program, to offer selected eligible persons the ability to purchase prescription drugs. The board may establish varying levels of eligibility and cost-sharing criteria as needed for selected eligible persons and, if established, shall ensure that cost-containment […]
Section 59A-54-7.2 – Expansion of programs pursuant to federal law.
The board may: A. establish a health plan to offer selected eligible individuals the ability to purchase or enroll in a program pursuant to federal law that provides expanded coverage for state high-risk pools; B. establish eligibility and coverage criteria as needed for selected eligible individuals; C. establish the cost-sharing amounts payable by a selected […]