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1. Not less than eighty-seven and one-half percent of the association plan premium paid to the lead carrier may be used to pay claims.
2. Any income in excess of the costs incurred by the association in providing reinsurance or administrative services must be held at interest and used by the association to offset past and future losses due to claims expenses of the association or be allocated to reduce benefit plan premiums.
3. The lead carrier agreement must continue for a period of at least three years, unless a request to terminate is approved by the board. The board shall approve or deny a request to terminate within ninety days of its receipt. A failure to make a final decision on a request to terminate within the specified period is deemed an approval. The agreement will be automatically renewed until either party terminates the agreement.
4. The lead carrier must be reimbursed from the association plan premiums received for its direct and indirect expenses. Direct and indirect expenses include a prorated reimbursement for the portion of the lead carrier's administrative, printing, claims administration, management, and building overhead expenses which are assignable to the maintenance and administration of the association. Direct and indirect expenses may not include costs directly related to the original submission of policy forms prior to selection as the lead carrier.
5. The lead carrier is, when carrying out its duties under this chapter, an agent of the association and the board, and is civilly liable for its actions, subject to the laws of this state.
6. The lead carrier shall:
a. Perform all administrative and claims payment functions required under this chapter.
b. Determine eligibility of individuals requesting coverage through the association.
c. Provide all eligible individuals involved in the association an individual certificate setting forth a statement as to the insurance protection to which the individual is entitled, the method and place of filing claims, and to whom benefits are payable. The certificate must indicate that coverage was obtained through the association.
d. Pay all claims under this chapter and indicate that the association paid the claims. Each claim payment must include information specifying the procedure involved in the event a dispute over the amount of payment arises.
e. Establish a premium billing procedure for collection of premium from individuals covered by the association.
f. Obtain approval from the board for all benefit plan premiums and benefit plans issued.
g. Submit regular reports to the board regarding the operation of the association.
h. Submit to the participating companies and board, on a semiannual basis, a report of the operation of the association.
i. Verify premium volumes of all health insurers in the state.
j. Determine and collect assessments.
k. Perform such functions relating to the association as may be assigned to it.
Cite this article: FindLaw.com - North Dakota Century Code Title 26.1. Insurance § 26.1-08-10. Administration of the association - last updated January 01, 2020 | https://codes.findlaw.com/nd/title-26-1-insurance/nd-cent-code-sect-26-1-08-10/
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