Reinsurance Program

Final State Reinsurance Annual Report

Oct. 12, 2021
Final Annual 1332 Waiver Report for 2020

Aug. 27, 2020 
As outlined in the specific terms and conditions for Maryland’s 1332 State Innovation Waiver, the Maryland Health Benefit Exchange must publish the final annual report of the State Reinsurance Program.

1332 General Information

Under Section 1332 of the Affordable Care Act, states may apply for State Innovation Waivers to waive certain federal requirements with the goal of improving their health insurance markets. During the 2018 legislative session, the Maryland General Assembly passed House Bill 1795 – Establishment of a State Reinsurance Program. Governor Larry Hogan signed House Bill 1795 on April 5, 2018.

House Bill 1795, as an emergency measure, directs the Maryland Health Benefit Exchange to submit a State Innovation Waiver to the U.S. Secretaries of Health and Human Services and the Treasury to establish a State Reinsurance Program.

The purpose of the State Reinsurance Program is to mitigate the premium impact of high cost enrollees on carriers that participate in the individual market. The State Reinsurance Program will reduce rates from what they would have been without the program, creating some relief for Marylanders who have experienced high rate increases on their health insurance premiums.

For more information on State Innovation Waivers, visit the CMS Section 1332: State Innovation Waivers website.

Application & Documents

Public Comment and Hearings

States are required to post State Innovation Waiver Applications for public comment for a minimum of 30 days. All comments should be submitted to the Maryland Health Benefit Exchange at mhbe.publiccomments@maryland.gov.

As a requirement of the State Innovation Waiver application process, the Maryland Health Benefit Exchange, in conjunction with the Maryland Insurance Administration, held four public hearings around the state from April 20 to May 20, 2018.

Hearing Agenda & Presentations

1332 Waiver Public Hearing Agenda
Presentation on “Maryland State Innovation Waiver Application: State Reinsurance Program, April 20-May 20, 2018”

Resources

Enacting Legislation:
HB 1795 – Establishment of a State Reinsurance Program
SB 387 – Maryland Health Access Act of 2018

Authorizing Resolution:
MHBE Board Resolution on the State Reinsurance Program and Submission of a State Innovation Waiver Application – April 16, 2018
Section 1332 Waiver -Public Comment – Board Presentation – May 21, 2018
Resolution 1332 State Innovation Waiver Application – May 21, 2018

Public Comment and Hearings

The Maryland Health Benefit Exchange hosted four public hearings. 

A summary presentation of proposed, incorporated comments can be viewed here.

Proposed State Reinsurance Program Regulations

House Bill 1795 requires the Maryland Health Benefit Exchange to adopt regulations implementing the State Reinsurance Program. These regulations must take effect by Jan. 1, 2019. As part of the regulatory process, the Maryland Health Benefit Exchange hosted a series of hearings to engage with the public to discuss the scope, design, and goals of these regulations. The Maryland Health Benefit Exchange staff considered all comments and feedback and incorporated input that was deemed appropriate. The updated proposed regulations can be viewed here.

Reports

April 22, 2020 State Reinsurance Carrier Annual Report Template

Pursuant to COMAR 14.35.17.03(C), all carriers participating in the State Reinsurance Program (SRP) are required to submit an annual report to the Maryland Health Benefit Exchange (MHBE) that describes carrier activities to manage the costs and utilization of enrollees whose claims were reimbursed under the SRP, as well as efforts to contain costs. MHBE is seeking comments on the reporting template. Please provide comments by Friday May 22, 2020, 5 p.m. to mhbe.publiccomments@maryland.gov

Draft Reinsurance Program Accountability Report Requirements
Draft Reinsurance Program Accountability Report Template
Comments on Accountability Reports

April 17, 2020 State Reinsurance Program Update

As outlined in the specific terms and conditions for Maryland’s 1332 State Innovation Waiver, the Maryland Health Benefit Exchange is required to submit a draft annual report to the Department of Health and Human Services within 90 days after the end of the first waiver year. MHBE is seeking comments on the draft annual report by May 18, 2020. All comments should be emailed to mhbe.publiccomments@maryland.gov.

Sept. 17, 2019 State Reinsurance Program Update

Each year, the Maryland Health Benefit Exchange Board of Trustees must set the payment parameters for the SRP by determining the attachment point, the coinsurance rate, and the reinsurance cap. MHBE has contracted with the actuarial firm, Lewis & Ellis, to provide an updated actuarial analysis of the Maryland individual health insurance market to assist the Board in setting the 2020 payment parameters and the 2020 dampening factor for the SRP.

A final draft of the report is available here.

Please submit any comments on the draft report by October 17th to mhbe.policy@maryland.gov.

Public Meeting

July 16, 2021 Annual Public Forum Meeting

Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange is affording the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP).
Reinsurance Forum Presentation Slides
Meeting Minutes

The Department of Health and Human Services and the Department of the Treasury has determined that Maryland has been approved to modify the post-award forum procedures, and will be holding our forum virtually, as outlined in the requirements set forth in 45 CFR §155.1320(c)(2).

June 17, 2020 Annual Public Forum Meeting

Pursuant to 31 CFR S33.120(c) and 45 CFR $155.1320(c), the Maryland Health Benefit Exchange afforded the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP).
Meeting Recording
Reinsurance Forum Presentation Slides
Meeting Minutes and Submitted Written Comments

May 2, 2019 Public Forum

MHBE hosted the first post-award forum regarding the State Reinsurance Program. The forum is an opportunity for the public to present meaningful comments on the progress of the State Reinsurance Program. Below are links to the presentation from the forum, the attendee sign-in sheet, and the minutes from the meeting:
Presentation on for the First Annual State Reinsurance Program Public Forum, May 2, 2019
Attendee Sign-In Sheet
Minutes
Written Testimony