LD 1496
pg. 13
Page 12 of 41 An Act To Reduce Maine's Health Insurance Rates and Expand Consumer Choice ... Page 14 of 41
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LR 541
Item 1

 
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
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
expenses incurred in the performance of its services. As used in
this subsection, "direct and indirect expenses" includes that
portion of the audited administrative costs, printing expenses,
claims administration expenses, management expenses, building
overhead expenses and other actual operating and administrative
expenses of the plan administrator that are approved by the board
as allocable to the administration of the plan and included in
the bid specifications.


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