SB 338 — Commonwealth Health Reinsurance Program; federal risk adjustment program.

SESSION ENROLLED VIRGINIA ACTS OF ASSEMBLY ––-- 2022 SESSION CHAPTER E547 An Act to amend and reenact §§ 38.2-6600 and 38.2-6602, as they may become effective, of the Code of program.,Virginia, relating to the Commonwealth Health Reinsurance Program;

federal risk adjustment Rprogram. O [S 338] L Approved L Be it enacted by the General Assembly of Virginia:

E[S 1.338] Approved April 11, 2022 Be it enacted by the General Assembly of Virginia:

That1. §§ 38.2-6600 and 38.2-6602, as they may become effective, of the Code of Virginia are D ame§ 38.2-6600.

That §§ 38.2-6600 and 38.2-6602, as they may become effective, of the Code of Virginia are amended and reenacted as follows:

§ 38.2-6600.

111-148, as amendedfurther byamended.ealth the Health Care and Education Reconciliation Act of 2010, P.L.

111-152, and as it may be further"Allowed amended.amount" has the same meaning as provided in § 38.2-3438.

"Allowed"Attachment amount"point" hasmeans the sameamount meaningset asby providedthe Commission for claims costs incurred by an eligible carrier for a covered person's covered benefits in §a 38.2-3438.benefit year, above which the claims costs for benefits are eligible for reinsurance payments under the Program.

"Attachment"Benefit point" means the amount set by the Commission for claims costs incurred by an elBgible carrier for a covered person's covered benefits in a benefit year, above which the claims costs3for ben"Benefit year" means the calendar year for which an eligible carrier provides coverage throuEhthrough an individual health benefit plan.

R "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 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 nonenforcement policy.age, nor transitional coverage that the federal government allows under a "Eligible carrier" means a carrier that (i) offers individual health insurance coverage other than a grandfathered plan, student health insurance coverage, ornor transitional coverage that the federal government allows under a nonenforcement policypolicy. and (ii) incurs claims costs for a covered person's covered benefits in the applicable benefit year.

"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.

"Group health insurance coverage" has the same meaning as provided in § 38.2-3438.

"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 forefor benefits are no longer eligible for reinsurance payments under the Program.

established.02.§ 38.2-6602.

established.

The Commission shall implement a reinsurance program, known as the Commonwealth Health of 2 Reinsurance Program.

If the State of 2 Innovation Waiver and federal funding request submitted by the Commission pursuant to § 38.2-6606 are approved, the Commission shall implement and operate the Program in accordance with this section.