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This entry was published on 2014-09-22
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SECTION 4309
Limitation on expenses
Insurance (ISC) CHAPTER 28, ARTICLE 43
§ 4309. Limitation on expenses. (a) No corporation subject to the
provisions of this article shall, during any one year, disburse more
than the percentages hereafter prescribed of the aggregate amount of the
premiums received during such year as expenditures for expenses, which,
for the purposes of this article, shall include all expenses paid or
incurred by the corporation which do not constitute benefit payments
made to or on behalf of persons covered under contracts issued by such
corporations:

(1) For hospital service corporations: fifteen per centum reduced by
one per centum for each five million dollars or fraction thereof above
one million dollars of premiums received to ten per centum.

(2) All other corporations: twenty per centum reduced by one per
centum for each five million dollars or fraction thereof above one
million dollars of premiums received to fifteen per centum except that
for any corporation which derives more than fifty per centum of its
premiums received from the sale of contracts which provide hospital
service benefits: seventeen and one-half per centum reduced by one per
centum for each five million dollars or fraction thereof above one
million dollars of premiums received to twelve and one-half per centum.

(3) Upon written application, the superintendent may waive the
limitations in paragraph one or two of this subsection for any
corporation which has not attained the level of enrollment which it
needs to attain a break-even position. The break-even position is
attained when the amount of annual losses and expenses incurred by the
corporation is equal to the amount of premiums earned during this
period. Such corporation shall be subject to such limitations in the
calendar year following the year in which it attains a break-even
position.

(b) If any such corporation shall in any calendar year make or incur
expenses as hereinabove defined in excess of its expense limit the
superintendent may, upon written application of such corporation and a
showing that such corporation has taken steps in accordance with a plan
submitted by the corporation and approved by the superintendent which
will enable it to comply with the provisions of this section during the
next calendar year, suspend the expense limit for such corporation for
the calendar year in which the excess was incurred but the
superintendent shall not suspend the expense limit for any such
corporation for more than two calendar years in succession.