| | |
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. |
|
|