Sec. 10.25.01.14. Payment of the Premium Subsidy

A. Payment of the total premium subsidy is subject to the following:

(1) The total premium subsidy for each enrolled employer shall be paid to the subsidy administrator and shall reduce the total premium owed by the enrolled employer;

(2) The enrolled employer shall pass the employee premium subsidy to the enrolled employee in the form of reduced payroll deductions for the health benefit plan;

(3) The employee premium subsidy is calculated as the premium subsidy for that employee's coverage multiplied by the ratio of the sum of the employee premium plus the employee's eligible HSA contribution, if any, to the sum of the premium, the employer's eligible HSA contribution, if any, and the employee's eligible HSA contribution, if any;

(4) Each month, the subsidy administrator or participating carrier shall invoice the enrolled employer for the total premium due for the subsequent month, minus the subsidy amount for enrolled employees registered in the Commission registry;

(5) At the time the enrolled employer is invoiced for the premium by the subsidy administrator or participating carrier, the subsidy administrator or participating carrier shall submit an invoice to the Commission, in a format set forth in the written participation agreement between the Commission and the participating carrier, that lists, for each enrolled employer, the invoiced premium and the premium subsidy due for each enrolled employee;

(6) The Commission shall promptly forward the invoice to the Comptroller for payment of the premium subsidy to the subsidy administrator or participating carrier;

(7) The subsidy payment is accounted for separately from other funds and is not considered to be earned by the participating carrier until the participating carrier has received the corresponding premium payment from the enrolled employer; and

(8) Each month, the subsidy administrator or participating carrier shall provide to the Commission, in a format set forth in the written participation agreement between the Commission and the participating carrier, the following:

(a) A list of all premium payments received from enrolled employers during the previous month, including the coverage period for which each premium payment was made; and

(b) A list of the enrolled employees covered by each premium payment.

B. Each premium subsidy paid in advance to a participating carrier that does not correspond to an enrolled employer's premium payment shall be deducted from a subsequent premium subsidy paid to the participating carrier, and a reconciliation statement shall be provided by the Commission to the participating carrier.