§ 26-43-104 — Administrator

Wyoming § 26-43-104

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 43: HEALTH CARE

Text

(a) The board shall select an insurer, insurers or a third
party administrator or administrators through a competitive
bidding process to administer the pool. The board shall
evaluate bids based on criteria established by the board which
shall include but are not limited to:
(i) The proven ability of the administrator to handle
individual accident and health insurance;
(ii) The efficiency of the claim paying procedures of
the administrator;
(iii) An estimate of total charges for administering
the plan;
(iv) The ability of the administrator to administer
the pool in a cost efficient manner.
(b) The administrator shall serve for a period determined
by the board of not less than three (3) years and not more than
five (5) years and is subject to removal for cause. At least
one (1) year prior to the expiration of the period of service by
an administrator, the board shall invite all insurers, including
the current administrator to submit bids to serve as the
administrator for the succeeding period. Selection of the
administrator for the succeeding period shall be made at least
six (6) months prior to the end of the current period.
(c) The administrator shall:
(i) Perform all eligibility and administrative claims
payment functions relating to the pool;
(ii) Establish a premium billing procedure for
collection of premiums from insureds. Billings shall be made
periodically as determined by the board;
(iii) Perform all necessary functions to assure
timely payment of benefits to covered persons under the pool
including but not limited to:
(A) Making available information relating to the
proper manner of submitting a claim for benefits to the pool and
distributing forms upon which submission is made;
(B) Evaluating the eligibility of each claim for
payment by the pool.
(iv) Submit regular reports to the board regarding
the pool operation. The board shall determine the frequency,
content and form of the report;
(v) Determine net written and earned premiums, the
expense of administration and the paid and incurred losses for
the year and report the information to the board and the
department on a form and in the manner prescribed by the
commissioner;
(vi) Receive payment as provided in the plan of
operation for its expenses incurred in the performance of its
services.