376.964. Board, powers and duties--including providing for issuing policies and reinsuring risks--staff appointment--rulemaking authority.
Board, powers and duties--including providing for issuing policies andreinsuring risks--staff appointment--rulemaking authority.
376.964. The board of directors and administering insurers of thepool shall have the general powers and authority granted under the laws ofthis state to insurance companies licensed to transact health insurance asdefined in section 376.960, and, in addition thereto, the specificauthority to:
(1) Enter into contracts as are necessary or proper to carry out theprovisions and purposes of sections 376.960 to 376.989, including theauthority, with the approval of the director, to enter into contracts withsimilar pools of other states for the joint performance of commonadministrative functions, or with persons or other organizations for theperformance of administrative functions;
(2) Sue or be sued, including taking any legal actions necessary orproper for recovery of any assessments for, on behalf of, or against poolmembers;
(3) Take such legal actions as necessary to avoid the payment ofimproper claims against the pool or the coverage provided by or through thepool;
(4) Establish appropriate rates, rate schedules, rate adjustments,expense allowances, agents' referral fees, claim reserve formulas and anyother actuarial function appropriate to the operation of the pool. Ratesshall not be unreasonable in relation to the coverage provided, the riskexperience and expenses of providing the coverage. Rates and rateschedules may be adjusted for appropriate risk factors such as age and areavariation in claim costs and shall take into consideration appropriate riskfactors in accordance with established actuarial and underwritingpractices;
(5) Assess members of the pool in accordance with the provisions ofthis section, and to make advance interim assessments as may be reasonableand necessary for the organizational and interim operating expenses. Anysuch interim assessments are to be credited as offsets against any regularassessments due following the close of the fiscal year;
(6) Issue policies of insurance in accordance with the requirementsof sections 376.960 to 376.989;
(7) Appoint, from among members, appropriate legal, actuarial andother committees as necessary to provide technical assistance in theoperation of the pool, policy or other contract design, and any otherfunction within the authority of the pool;
(8) Establish rules, conditions and procedures for reinsuring risksof pool members desiring to issue pool plan coverages in their own name.Such reinsurance facility shall not subject the pool to any of the capitalor surplus requirements, if any, otherwise applicable to reinsurers;
(9) Negotiate rates of reimbursement with health care providers onbehalf of the association and its members;
(10) Administer separate accounts to separate federally definedeligible individuals and trade act eligible individuals who qualify forplan coverage from the other eligible individuals entitled to pool coverageand apportion the costs of administration among such separate accounts.
(L. 1990 H.B. 998 § 2 subsec. 6, A.L. 2007 H.B. 818)Effective 1-01-08