Maine § 24-A §1954 Duties

Maine Statutes

§ 24-A §1954 — Duties

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 18-A PRIVATE PURCHASING ALLIANCES

An alliance shall:

1.Carrier eligibility. Develop and make available a list of objective criteria, subject to rules adopted by the superintendent, that participating carriers must meet in order to be eligible to participate in the alliance;

2.Enrollee choice. Ensure that enrollees have a choice among a reasonable number of competing carriers and types of health benefit plans.

3.Enrollment. Develop standard enrollment procedures in accordance with rules adopted by the superintendent;

4.Plan descriptions. Publish educational materials, plan descriptions and comparison sheets describing participating carriers and the health benefit plans available through the alliance for use in enrolling eligible members. The information may include an assessment of utilization management procedures and

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An alliance shall:
1.
Carrier eligibility.
Develop and make available a list of objective criteria, subject to rules adopted by the superintendent, that participating carriers must meet in order to be eligible to participate in the alliance;
2.
Enrollee choice.
Ensure that enrollees have a choice among a reasonable number of competing carriers and types of health benefit plans.
3.
Enrollment.
Develop standard enrollment procedures in accordance with rules adopted by the superintendent;
4.
Plan descriptions.
Publish educational materials, plan descriptions and comparison sheets describing participating carriers and the health benefit plans available through the alliance for use in enrolling eligible members. The information may include an assessment of utilization management procedures and the level of quality and cost-effective care;
5.
Enrollee eligibility.
Establish eligibility standards for membership in accordance with rules adopted by the superintendent. Eligibility standards may not relate to health status;
6.
Acceptance of enrollees.
Accept all applicants for membership that meet the alliance's eligibility standards;
7.
Risk pools.
Develop standards for classifying groups of participating members into risk pools. The risk pools may include one or more risk pools for enrolled employees and their dependents and a risk pool for enrolled individuals and their dependents;
8.
Annual report.
Prepare an annual report on the operations of the alliance to the superintendent, which must include an accounting of all outside revenues received by the alliance and internal and independent audits and any other information the superintendent may require;
9.
Trust account.
Maintain a trust account or accounts for deposit of all money received and collected for the operation of the alliance. An alliance and its board members, employees and agents have a fiduciary duty with respect to all money received or owed to it to ensure payments of its obligations and a full accounting to its members and the superintendent; and
10.
Violations.
Report to the superintendent any suspected or alleged law violations.
The superintendent may specify further duties by rule.