§ 27-20.7-7 - Responsibilities of the insurer.
SECTION 27-20.7-7
§ 27-20.7-7 Responsibilities of theinsurer. – (a) If an insurer utilizes the services of an administrator, the insurer shallbe responsible for determining the benefits, premium rates, underwritingcriteria and claims payment procedures applicable to the coverage and forsecuring reinsurance, if any. The rules pertaining to these matters must beprovided, in writing, by the insurer to the administrator. The responsibilitiesof the administrator as to any of these matters shall be set forth in thewritten agreement between the administrator and the insurer.
(b) It is the sole responsibility of the insurer to providefor competent administration of its programs.
(c) In cases where an administrator administers benefits formore than one hundred (100) certificate holders on behalf of an insurer, theinsurer shall, at least semi-annually, conduct a review of the operations ofthe administrator. At least one of these reviews shall be an on-site audit ofthe operations of the administrator.