31.10.22.15

.15 Insurance — Catastrophic or Back-Up Coverage.

A. Insurance Coverage Required. Unless the Commissioner grants an exemption from the requirements of this section, a provider-sponsored organization shall secure insurance coverage to provide:

(1) Payments or services required to be made or furnished under the health care contract to those enrollees who are injured or become ill outside the geographic limits served by the provider-sponsored organization; and

(2) Reinsurance protection to the provider-sponsored organization in the event of catastrophic or unusual losses that would be in excess of the levels of loss that the provider-sponsored organization assumes in the basis of its calculation of premium charges.

B. Term and Renewal of Exemptions.

(1) Any exemption to the requirements of §A of this regulation shall be for a period of 1 year, and may be renewed from year to year after that.

(2) The provider-sponsored organization shall make any request for renewal of an exemption at least 90 days before the expiration date of the then-current exemption.

C. Reinsurance. With the approval of the Commissioner, a provider-sponsored organization may reinsure any portion or aspect of its operation.