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2002 SESSION

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HB 624 Third party administrators of employee health benefits.

Introduced by: Harvey B. Morgan | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Third party administrators; penalties. Regulates the business of administrators of certain insured or self-insured employee health benefits plans. Administrators are required to be licensed by the State Corporation Commission, post a surety bond, and pay an annual fee. Agreements between an administrator and the principal sponsoring the benefits plan must be in writing and set forth the underwriting standards under the plan. Premiums and contributions held by an administrator must be held in fiduciary accounts. Administrators are prohibited from engaging in certain practices, including misrepresenting facts relating to coverage, failing to act reasonably and promptly upon communications with respect to a claim for benefits, and failing to adopt reasonable standards for the prompt investigation of a claim for benefits. Administrators may not be compensated based on the plan's loss experience. Violators are subject to fines of up to $2,500. Acting as an administrator without obtaining a license is punishable as a Class 1 misdemeanor.


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