11 N.C. Admin. Code 16.0703

Current through Register Vol. 39, No. 12, December 1, 2024

Section 16 .0703 - CLAIM RESERVE FILING REQUIREMENTS

(a) A quarterly claim reserve data filing shall be made by any HMO that has been in operation for more than one full calendar year but less than three full calendar years.

(b) An annual claim reserve data filing shall be made by any HMO that satisfies either of the following conditions:

(1) for the most recent quarterly valuation the net worth less the contingency reserve is less than the statutory minimum stated in G.S. 58-67-110(c) or G.S. 58-67-110(d); or

(2) for the most recent annual valuation the sum of the following exceeds 110 percent of the estimated liability of unpaid claims on December 31 of the previous year:

(A) total of claims paid during the year and incurred in previous years; and

(B) claims unpaid at December 31 of the current year on claims incurred in previous years.

(c) A triennial claim reserve data filing shall be made by all HMOs.

(d) All annual and triennial claim reserve data filings shall be sent to the Actuarial Services Division by March 1 of the reporting year.

(e) All quarterly claim reserve data filings shall be sent to the Actuarial Services Division within 45 days after the end of each calendar quarter.

11 N.C. Admin. Code 16 .0703

Authority G.S. 58-2-40; 58-67-135(b); 58-67-150;
Eff. February 1, 1995;
Amended Eff. April 1, 1997;
Readopted Eff. October 1, 2018.

Authority G.S. 58-2-40; 58-67-135(b); 58-67-150;
Eff. February 1, 1995;
Amended Eff. April 1, 1997.

Adopted by North Carolina Register Volume 33, Issue 09, November 1, 2018 effective 10/1/2018.