33-35-203. Requirements applicable only to arrangements organized after October 1, 1995.
33-35-203. Requirements applicable only to arrangements organized after October 1, 1995. (1) In addition to the requirements of 33-35-202, self-funded multiple employer welfare arrangements formed after October 1, 1995, are subject to the following requirements:
(a) arrangements shall maintain a calendar year for operations and reporting purposes unless the commissioner consents to a fiscal year;
(b) arrangements shall satisfy one of the following requirements:
(i) (A) the arrangement shall deposit $200,000 with the commissioner pursuant to Title 33, chapter 2, part 6, to be used for the payment of claims in the event that the arrangement becomes insolvent; and
(B) the arrangement shall submit to the commissioner a written plan of operation that, in the reasonable discretion of the commissioner, ensures the financial integrity of the arrangement; or
(ii) the arrangement demonstrates to the reasonable satisfaction of the commissioner the ability of the arrangement to remain financially solvent, for which purpose the commissioner may consider:
(A) the pro forma financial statements of the self-funded multiple employer welfare arrangement;
(B) the types and levels of excess of loss insurance coverage, including the attachment points of the coverage and whether the points are reflected as annual or monthly levels;
(C) whether a deposit is required for each employee covered under the arrangement equal to at least one month's cost of providing benefits under the arrangement;
(D) the experience of the individuals who will be involved in the management of the arrangement, including employees, independent contractors, and consultants; and
(E) other factors as reasonably determined by the commissioner to be relevant to a determination of whether the arrangement is able to operate in a financially solvent manner.
(2) Financial information relating to the employers is subject to the confidentiality provisions of 33-1-409(6).
(3) The commissioner may require that the articles, bylaws, agreements, trusts, or other documents or instruments describing the rights and obligations of the employers, employees, and beneficiaries of the arrangement provide that employers participating in the arrangement are subject to pro rata assessment for all liabilities of the arrangement.
(4) Arrangements shall maintain excess of loss insurance coverage covering 100% of claims in excess of the designated attachment point. The commissioner may waive the requirement of excess of loss insurance coverage.
(5) An arrangement shall submit its base contribution rates for participation under the arrangement for its initial year of operations for review and approval by the commissioner.
(6) The commissioner may require continued compliance with respect to the conditions set forth in this section as a condition of granting a certificate of authority to an arrangement. The commissioner may waive continued compliance with respect to the conditions in this section at any time after the commissioner has granted a certificate of authority to an arrangement.
History: En. Sec. 6, Ch. 420, L. 1995.