Title 38.2. Insurance
Chapter 66. Commonwealth Health Reinsurance Program
§ 38.2-6600. Definitions.
As used in this chapter, unless the context requires a different meaning:
"Affordable Care Act" means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, P.L. 111-152, and as it may be further amended.
"Allowed amount" has the same meaning as provided in § 38.2-3438.
"Attachment point" means the amount set by the Commission for claims costs incurred by an eligible carrier for a covered person's covered benefits in a benefit year, above which the claims costs for benefits are eligible for reinsurance payments under the Program.
"Benefit year" means the calendar year for which an eligible carrier provides coverage through an individual health benefit plan.
"Coinsurance rate" means the rate set by the Commission at which the Program will reimburse an eligible carrier for claims incurred for a covered person's covered benefits in a benefit year, which claims exceed the attachment point but are below the reinsurance cap.
"Covered benefits" has the same meaning as provided in § 38.2-3438.
"Covered person" means an individual covered under individual health insurance coverage that (i) is delivered or issued for delivery in the Commonwealth and (ii) is neither a grandfathered plan, student health insurance coverage, nor transitional coverage that the federal government allows under a nonenforcement policy.
"Eligible carrier" means a carrier that (i) offers individual health insurance coverage other than a grandfathered plan, student health insurance coverage, or transitional coverage that the federal government allows under a nonenforcement policy and (ii) incurs claims costs for a covered person's covered benefits in the applicable benefit year.
"Fund" means the Commonwealth Health Reinsurance Program Special Fund established by the Commission pursuant to § 38.2-6604.
"Grandfathered plan" has the same meaning as provided in § 38.2-3438.
"Group health insurance coverage" has the same meaning as provided in § 38.2-3438.
"Individual health insurance coverage" has the same meaning as provided in § 38.2-3438.
"Net written premiums" means premiums earned on individual and group health insurance coverage, including grandfathered plans, in the Commonwealth, less return premiums and dividends paid or credited to policy or contract holders on the health benefits plan business.
"Payment parameters" means the attachment point, reinsurance cap, and coinsurance rate for the Program.
"Program" means the Commonwealth Health Reinsurance Program established pursuant to this chapter.
"Reinsurance cap" means the amount set by the Commission for claims costs incurred by an eligible carrier for a covered person's covered benefits in a benefit year, above which the claims costs for benefits are no longer eligible for reinsurance payments under the Program.
"Reinsurance payment" means an amount paid to an eligible carrier under the Program.
"State Innovation Waiver" means a waiver of one or more requirements of the Affordable Care Act authorized by § 1332 of the Affordable Care Act, 42 U.S.C. § 18052, and applicable federal regulations.
"Total amount paid by the eligible carrier for any eligible claim" means the amount paid by the eligible carrier based on the allowed amount less any deductible, coinsurance, or copayment, as of the time applicable data is submitted or made accessible under subdivision C 1 of § 38.2-6602.
