Plan Approval. The new Section 1860D-13 would prohibit the Administrator from approving a plan unless the premium, for both standard coverage and for any additional benefits, accurately reflected the actuarial value of the benefits less the actuarial value of reinsurance payments and any stabilization funds used. The bid submitted by an entity for a qualified plan must reasonably and equitably reflect the cost of benefits provided under that plan. The Administrator would have the authority to negotiate the terms and conditions of the proposed monthly premiums and other terms and conditions of proposed plans. The Administrator could disapprove, or limit enrollment in, a proposed plan based on costs to beneficiaries, the quality of coverage and benefits, the adequacy of the plan network, average aggregate projected costs of covered drugs and other factors determined appropriate by the Administrator. The Administrator could approve a plan only if it provided the required benefits and was not designed to result in a favorable selection of beneficiaries. The Administrator would approve at least 2 contracts to offer a Medicare Prescription Drug plan in an area. Contracts would be awarded for 2 years.
Appears in 4 contracts
Samples: Conference Agreement, Conference Agreement, Conference Agreement
