601.80 Definitions; healthcare stability plan. In this subchapter:

(1) “Affordable Care Act” means the federal Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, P.L. 111-152, and any amendments to or regulations or guidance issued under those acts.

(2) “Attachment point” means the amount set under s. 601.83 (2) for the healthcare stability plan that is the threshold amount for claims costs incurred by an eligible health carrier for an enrolled individual's covered benefits in a benefit year, beyond which the claims costs are eligible for reinsurance payments.

(3) “Benefit year” means the calendar year for which an eligible health carrier provides coverage through an individual health plan.

(4) “Coinsurance rate” means the rate set under s. 601.83 (2) for the healthcare stability plan that is the rate at which the commissioner will reimburse an eligible health carrier for claims incurred for an enrolled individual's covered benefits in a benefit year above the attachment point and below the reinsurance cap.

(5) “Eligible health carrier” means an insurer, as defined in s. 632.745 (15), that offers an individual health plan and incurs claims costs for an enrolled individual's covered benefits in the applicable benefit year.

(6) “Grandfathered plan” means a health plan in which an individual was enrolled on March 23, 2010, for as long as it maintains that status in accordance with the Affordable Care Act.

(7) “Health benefit plan” has the meaning given in s. 632.745 (11).

(8) “Healthcare stability plan” means the state-based reinsurance program known as the Wisconsin Healthcare Stability Plan administered under s. 601.83 (1).

(9) “Individual health plan” means a health benefit plan that is not a group health plan, as defined in s. 632.745 (10), or a grandfathered plan.

(10) “Payment parameters” means the attachment point, reinsurance cap, and coinsurance rate for the healthcare stability plan.

(12) “Reinsurance cap” means the threshold amount set under s. 601.83 (2) for the healthcare stability plan for claims costs incurred by an eligible health carrier for an enrolled individual's covered benefits, after which the claims costs for benefits are no longer eligible for reinsurance payments.

(13) “Reinsurance payment” means an amount paid by the commissioner to an eligible health carrier under the healthcare stability plan.

History: 2017 a. 138.