627.649 Administrator.
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627.649 Administrator.
(1) The board shall select an administrator, through a competitive bidding process, to administer the plan. The board shall evaluate bids submitted under this subsection based on criteria established by the board, which criteria shall include:
(a) The administrator’s proven ability to handle large group accident and health insurance, and due consideration shall be given to any administrator who has acted as a third-party administrator for the state group health insurance program pursuant to s. 110.123.
(b) The extent to which the administrator has developed a network of health care providers for providing managed health care on a statewide basis.
(c) The efficiency of the administrator’s claims-paying procedures.
(d) An estimate of total charges for administering the plan.
(2) The administrator shall serve for a period of 3 years. At least 1 year prior to the expiration of each 3-year period of service by an administrator, the board shall invite all insurers, including the current administering insurer, to submit bids to serve as the administrator for the succeeding 3-year period. The selection of the administrator for the succeeding period shall be made at least 6 months prior to the end of the current 3-year period.
(3) The administrator shall:
(a) Perform all eligibility and administrative claims-payment functions relating to the plan.
(b) Pay an agent’s referral fee as established by the board to each insurance agent who refers an applicant to the plan, if the applicant’s application is accepted. The selling or marketing of plans shall not be limited to the administrator or its agents. The referral fees shall be paid by the administrator from moneys received as premiums for the plan.
(c) Establish a premium-billing procedure for collection of premiums from insured persons. Billings shall be made periodically as determined by the board.
(d) Perform all necessary functions to assure timely payment of benefits under the plan, including:
1. Making available information relating to the proper manner of submitting a claim for benefits under the plan and distributing forms upon which submissions shall be made.
2. Evaluating the eligibility of each claim for payment under the plan.
3. Notifying each claimant within the time limits prescribed by law as to insurers after receiving a properly completed and executed proof of loss whether the claim is accepted, rejected, or compromised.
(e) Submit regular reports to the board regarding the operation of the plan. The frequency, content, and form of the reports shall be as determined by the board.
(f) Following the close of each calendar year, determine net premiums, reinsurance premiums less administrative expense allowance, the expense of administration pertaining to the reinsurance operations of the association, and the incurred losses of the year and report this information to the association and the office.
(g) Pay claims expenses from the premium payments received from or on behalf of covered persons under the plan. If the payments by the administrator for claims expenses exceed the portion of premiums allocated by the board for payment of claims expenses, the board shall provide the administrator with additional funds for payment of claims expenses to the extent that such funds are available.
(4)(a) The administrator shall be paid, as provided in the contract of the association, for its direct and indirect expenses incurred in the performance of its services.
(b) As used in this subsection, the term “direct and indirect expenses” includes that portion of the audited administrative costs, printing expenses, claims administration expenses, management expenses, building overhead expenses, and other actual operating and administrative expenses of the administering insurer which are approved by the board as allocable to the administration of the plan and included in the bid specifications.
History. ss. 496(2nd), 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 5, ch. 83-28; s. 106, ch. 83-216; s. 20, ch. 89-167; ss. 6, 13, 14, ch. 90-334; s. 4, ch. 91-429; s. 1160, ch. 2003-261; s. 22, ch. 2004-297.
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Note. Section 22, ch. 2004-297, provides that “[u]pon implementation, as defined in s. 627.64872(2), Florida Statutes, and as provided in s. 627.64872(20), Florida Statutes, of the Florida Health Insurance Plan created under s. 627.64872, Florida Statutes, sections 627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496, and 627.6498, Florida Statutes, are repealed.”