2023 -- H 5538 | |
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LC001899 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2023 | |
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A N A C T | |
RELATING TO INSURANCE -- THIRD PARTY HEALTH INSURANCE | |
ADMINISTRATORS | |
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Introduced By: Representatives Kennedy, and Diaz | |
Date Introduced: February 15, 2023 | |
Referred To: House Corporations | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 27-20.7-7 of the General Laws in Chapter 27-20.7 entitled "Third |
2 | Party Health Insurance Administrators" is hereby amended to read as follows: |
3 | 27-20.7-7. Responsibilities of the insurer. |
4 | (a) If an insurer utilizes the services of an administrator, the insurer shall be responsible for |
5 | determining the benefits, premium rates, underwriting criteria and claims payment procedures |
6 | applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters |
7 | must be provided, in writing, by the insurer to the administrator. The responsibilities of the |
8 | administrator as to any of these matters shall be set forth in the written agreement between the |
9 | administrator and the insurer. |
10 | (b) It is the sole responsibility of the insurer to provide for competent administration of its |
11 | programs. |
12 | (c) In cases where an administrator administers benefits for more than one hundred (100) |
13 | certificate holders on behalf of an insurer, the insurer shall, at least semi-annually, conduct a review |
14 | of the operations of the administrator. At least one of these reviews shall be an on-site audit of the |
15 | operations of the administrator. |
16 | SECTION 2. This act shall take effect upon passage. |
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LC001899 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- THIRD PARTY HEALTH INSURANCE | |
ADMINISTRATORS | |
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1 | This act would repeal the requirement that at least one of the semiannual reviews performed |
2 | by the insurer shall be an on-site audit of the operations of the administrator of benefits. |
3 | This act would take effect upon passage. |
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