LD 1190
pg. 11
Page 10 of 18 An Act To Create the Comprehensive Health Insurance Risk Pool Association Page 12 of 18
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LR 436
Item 1

 
the plan, if the applicant's application is accepted.__The
selling or marketing of the plan is not limited to the plan
administrator or its producers.__The plan administrator
shall pay the referral fees from funds received as premiums
for the plan;

 
C.__Establish a premium billing procedure for collection
of premiums from insured persons.__Billings must be made
periodically as determined by the board;

 
D.__Perform all necessary functions to ensure timely
payment of benefits to covered persons under the plan,
including:

 
(1)__Making available information relating to the
proper manner of submitting a claim for benefits
under the plan and distributing forms upon which
submissions must be made;

 
(2)__Evaluating the eligibility of each claim for
payment under the plan; and

 
(3)__Notifying each claimant within 45 days after
receiving a properly completed and executed proof of
loss whether the claim is accepted, rejected or
compromised. The board shall establish reasonable
reimbursement amounts for any services covered under
the benefit plans;

 
E.__Submit regular reports to the board regarding the
operation of the plan.__The frequency, content and form of
the reports must be as determined by the board;

 
F.__Following the close of each calendar year, determine
net premiums, reinsurance premiums less administrative
expense allowance, the expense of administration
pertaining to the reinsurance operations of the
association and the incurred losses of the year and report
this information to the superintendent; and

 
G.__Pay claims expenses from the premium payments received
from or on behalf of covered persons under the plan.__If
the payments by the plan administrator for claims expenses
exceed the portion of premiums allocated by the board for
payment of claims expenses, the board shall provide the
plan administrator with additional funds for payment of
claims expenses.

 
4.__Payment to plan administrator.__The plan administrator
selected pursuant to subsection 1 must be paid, as provided in
the contract of the association, for its direct and indirect


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