§ 26-43-114 — 26-43-102. Operation of the pool; board membership; board powers and duties

Wyoming § 26-43-114

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

Text

(a) There is created a nonprofit entity known as the
Wyoming health insurance pool. All insurers issuing health
insurance in this state and to the extent not preempted by
federal law, insurance arrangements providing health plan
benefits in this state on and after July 1, 1990, are members of
the pool. The commissioner shall give notice to all member
insurers and insurance arrangements of the time and place for
the initial meeting of the board appointed pursuant to W.S.
26-43-102(b).
(b) The board shall consist of seven (7) members including
the commissioner or his designated representative. The
commissioner shall appoint three (3) members from participating
insurers and three (3) members from the general public. Terms
of office for the appointed board members are four (4) years
except initial terms shall be less than four (4) years and
staggered as determined by the commissioner. The commissioner
shall establish procedures for filling vacancies on the board.
(c) Members of the board shall serve without compensation
but shall receive travel expenses and per diem from pool funds
in the same manner and amount as state employees for services
incurred for the board.
(d) The board shall:
(i) Select an administrator of the pool;
(ii) Submit to the commissioner a plan of operation
for the pool and any amendments to the plan necessary or
suitable to assure the fair, reasonable and equitable
administration of the pool. The commissioner shall approve the
plan of operation after notice and hearing provided the plan is
determined suitable to assure the fair, reasonable and equitable
administration of the pool and provides for the sharing of pool
gains or losses on an equitable proportionate basis. The plan
of operation is effective upon approval in writing by the
commissioner. If the board at any time thereafter fails to
submit suitable amendments to the plan, the commissioner shall
adopt reasonable rules after notice and hearing as necessary or
advisable to effectuate the provisions of this section. The
rules shall continue in force until modified by the commissioner
or superseded by a plan submitted by the board and approved by
the commissioner;
(iii) Have the general powers and authority granted
under the laws of this state to insurance companies licensed to
transact health insurance;
(iv) Establish for each eligibility level appropriate
rates, rate schedules, rate adjustments, expense allowances,
agents' referral fees, claim reserve formulas and any other
actuarial functions appropriate to the operation of the pool.
Rates and rate schedules may be adjusted for appropriate risk
factors such as age and area variation in claim cost and shall
take into consideration appropriate risk factors in accordance
with established actuarial and underwriting practices;
(v) Assess members of the pool in accordance with the
provisions of this act;
(vi) Issue policies of insurance in accordance with
the requirements of this act;
(vii) Repealed by Laws 2019, ch. 16, § 2.
(e) The plan of operation provided by paragraph (d)(ii) of
this section shall:
(i) Establish procedures for the handling, investing
and accounting of assets and monies of the pool;
(ii) Identify the administrator in accordance with
W.S. 26-43-104;
(iii) Establish procedures for the collection of
assessments to provide for claims paid under the plan and for
administrative expenses incurred or estimated to be incurred
during the period for which the assessments are made;
(iv) Establish the level of assessment payments
pursuant to W.S. 26-43-105;
(v) Develop and implement a program to publicize and
to maintain public awareness of the existence of the plan, the
eligibility requirements and procedures for enrollment;
(vi) Establish procedures for termination of pool
coverage of any person who ceases to meet the eligibility
requirements provided by W.S. 26-43-103;
(vii) Provide as necessary for audits of the pool and
the administration of the pool;
(viii) Allow every insurance agent licensed to sell
insurance in Wyoming to sell the policy.
(f) The board may:
(i) Enter into contracts as necessary or proper to
carry out the provisions and purposes of this act, including but
not limited to the authority, with the approval of the insurance
commissioner, to enter into contracts with similar pools of
other states for the joint performance of common administrative
functions or with persons or other organizations for the
performance of administrative functions;
(ii) Sue or be sued, including but not limited to
taking any legal actions necessary or proper for recovery of any
assessments for, on behalf of, or against pool members;
(iii) Take legal action as necessary to avoid the
payment of improper claims against the pool or the coverage
provided by or through the pool;
(iv) Appoint from among members appropriate legal,
actuarial and other committees as necessary to provide technical
assistance in the operation of the pool, policy and other
contract design and any other function within the authority of
the board;
(v) Repealed by Laws 2019, ch. 16, § 2.