LD 394
pg. 13
Page 12 of 21 An Act To Create a High-risk Pool in the Health Insurance Market Page 14 of 21
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LR 516
Item 1

 
B.__The efficiency of the insurer's claims-paying procedures;
and

 
C.__An estimate of total charges for administering the plan.

 
2.__Contract with plan administrator.__The plan administrator
selected pursuant to subsection 1 serves for a period of 3 years
pursuant to a contract with the association.__At least one year
prior to the expiration of that 3-year period of service, the
board shall invite all insurers, including the current plan
administrator, to submit bids to serve as the plan administrator
for the succeeding 3-year period.__The board shall select the
plan administrator for the succeeding period at least 6 months
prior to the ending of the 3-year period.

 
3.__Duties of plan administrator.__The plan administrator
selected pursuant to subsection 1 shall:

 
A.__Perform all eligibility and administrative claims-
payment functions relating to the plan;

 
B.__Pay a producer's referral fee as established by the
board to each producer that refers an applicant to 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 subject to compromise.__The board shall
establish reasonable


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