33-22-1514. Administration of association plan -- rules. (1) The association shall select one lead carrier to issue the association plan and the association portability plan. The board of directors of the association shall prepare appropriate specifications and bid forms and may solicit bids from licensed administrators and the members of the association for the purpose of selecting the lead carrier. The selection of the lead carrier must be based upon criteria established by the board of directors.
     (2) The lead carrier shall perform all administrative and claims payment functions required by this section upon the commissioner's approval of the policy forms and contracts submitted. The lead carrier shall provide these services for a period of at least 3 years, unless a request to terminate is approved by the association and the commissioner. The association and the commissioner shall approve or deny a request to terminate within 90 days of the receipt of the request. A failure to make a final decision on a request to terminate within the specified period is considered an approval. The association shall invite submissions of policy forms from members of the association, including the lead carrier, 6 months prior to the expiration of each 3-year period. The association shall follow the procedure provided in subsection (1) in selecting a lead carrier for the subsequent 3-year period or, if a request to terminate is approved, on or before the end of the 3-year period.
     (3) The lead carrier shall provide all eligible persons involved in the association plan and the association portability plan an individual certificate setting forth a statement as to the insurance protection to which the person is entitled, the method and place of filing claims, and to whom benefits are payable. The certificate must indicate that coverage was obtained through the association.
     (4) The lead carrier shall submit to the association, the legislative fiscal analyst, and the commissioner on a semiannual basis a report of the operation of the association plan and the association portability plan. The report must be provided in an electronic format. The association shall determine the specific information to be contained in the report prior to the effective date of the association plan and the association portability plan.
     (5) The lead carrier shall pay all claims pursuant to this part and shall indicate that the claim was paid by the association plan or the association portability plan. Each claim payment must include information specifying the procedure involved if a dispute arises over the amount of payment.
     (6) The lead carrier must be reimbursed from the association plan and the association portability plan premiums received for its direct and indirect expenses. Direct and indirect expenses include a prorated reimbursement for the portion of the lead carrier's administrative, printing, claims administration, management, and building overhead expenses, which are assignable to the maintenance and administration of the association plan and the association portability plan. The association shall approve cost accounting methods to substantiate the lead carrier's cost reports consistent with generally accepted accounting principles. Direct and indirect expenses may not include costs directly related to the original submission of policy forms prior to selection as the lead carrier.
     (7) The lead carrier is, when carrying out its duties under this part, an independent contractor for the association and is individually liable for the lead carrier's actions, subject to the laws of this state.

     History: En. Sec. 10, Ch. 595, L. 1985; amd. Sec. 28, Ch. 798, L. 1991; amd. Sec. 5, Ch. 528, L. 1999; amd. Sec. 32, Ch. 469, L. 2005; amd. Sec. 11, Ch. 120, L. 2013.