31A-34-109 - Operation of alliances.
31A-34-109. Operation of alliances.
An alliance shall:
(1) be operated by its board;
(2) contract with at least three insurers unaffiliated with each other to ensure thatenrollees have a choice from among a reasonable number of competing insurers and types ofhealth benefit plans. The commissioner may, by order, modify this requirement to allow analliance to contract with only two unaffiliated insurers if the commissioner finds thatmodification of this requirement may enhance competitive cost, quality, or access in the pricingand delivery of health insurance and that such modification does not prejudice the interests ofpotential members or enrollees;
(3) develop standard enrollment procedures;
(4) prepare and distribute educational materials, plan descriptions, and comparison sheetsdescribing contracted insurers and the health benefit plans available through the alliance toprospective members;
(5) receive, review, and act, as appropriate, on grievances by members and enrollees;
(6) establish administrative and accounting procedures for operating the alliance and forproviding services to members and enrollees;
(7) prepare an annual report for the commissioner on the operations of the alliance nolater than March 1, which shall include an accounting of all revenues received by the alliance,internal and independent audits, and other related information as the commissioner may require;
(8) establish procedures for billing and collecting premiums from members;
(9) establish procedures that allow an enrollee to transfer at least once each year toanother health benefit plan that is comparable in benefits and is available through the alliance;
(10) deposit and maintain all money received and collected for the operation of thealliance in trust with the clear understanding that the alliance, its board, employees, and agentshave a fiduciary duty to safeguard the money it receives, pursue funds that are owed, payoutstanding obligations, and account fully to alliance members and the commissioner; and
(11) establish marketing standards to be used by contracted insurers.
Enacted by Chapter 143, 1996 General Session