South Carolina Code 38-74-40. Administration of pool
(1) the insurer’s proven ability to handle accident and health insurance;
Terms Used In South Carolina Code 38-74-40
- Board: means the board of directors of the pool. See South Carolina Code 38-74-10
- Department: means the South Carolina Insurance Department. See South Carolina Code 38-74-10
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- insurance: includes annuities. See South Carolina Code 38-1-20
- Insured: means any individual resident of this State who is eligible to receive benefits from any insurer. See South Carolina Code 38-74-10
- Insurer: means any entity that provides health insurance in this State. See South Carolina Code 38-74-10
- Net loss: means the excess of incurred claims plus expenses over the sum of earned premiums, accrued investment income, and other appropriate gains and losses. See South Carolina Code 38-74-10
- Person: means a corporation, agency, partnership, association, voluntary organization, individual, or another entity, organization, or aggregation of individuals. See South Carolina Code 38-1-20
- Plan of operation: means the plan of operation of the pool, including articles, bylaws, and operating rules adopted by the board. See South Carolina Code 38-74-10
- Pool: means the South Carolina Health Insurance Pool. See South Carolina Code 38-74-10
- Premium: means payment given in consideration of a contract of insurance. See South Carolina Code 38-1-20
(2) the efficiency of the insurer’s claim-paying procedures;
(3) an estimate of total charges for administering the plan;
(4) the insurer’s ability to administer the pool in a cost-efficient manner;
(B)(1) The administering insurer shall serve for a period of three years subject to removal for cause.
(2) At least one year prior to the expiration on each three-year period of service by an administering insurer, the board shall invite all insurers, including the current administering insurer, to submit bids to serve as the administering insurer for the succeeding three-year period. Selection of the administering insurer for the succeeding period must be made at least six months prior to the end of the current three-year period.
(C)(1) The administering insurer shall perform all eligibility and administrative claims payment functions relating to the pool.
(2) The administering insurer shall establish a premium billing procedure for collection of premium from insured persons. Billings must be made on a periodic basis as determined by the board.
(3) The administering insurer shall perform all necessary functions to assure timely payment of benefits to a covered person under the pool including:
(a) making available information relating to the proper manner of submitting a claim for benefits to the pool and distributing forms upon which submission must be made;
(b) evaluating the eligibility of each claim for payment by the pool.
(4) The administering insurer shall submit regular reports to the board regarding the operation of the pool. The frequency, content, and form of the report are determined by the board.
(5) Following the close of each fiscal year, the administering insurer shall determine the net loss for the year and report this information to the board and the department on a form prescribed by the commissioner.
(6) The administering insurer is paid as provided in the plan of operation for its expenses incurred in the performance of its services.