2006 New Mexico Statutes - Section 59A-56-13 — Alliance administrator.

59A-56-13. Alliance administrator.

A.     The board may select an alliance administrator through a competitive request for proposal process. The board shall evaluate proposals based on criteria established by the board that shall include:   

(1)     proven ability to administer health insurance programs;   

(2)     an estimate of total charges for administering the alliance for the proposed contract period; and   

(3)     ability to administer the alliance in a cost-efficient manner.   

B.     The alliance administrator contract shall be for a period up to four years, subject to annual renegotiation of the fees and services, and shall provide for cancellation of the contract for cause, termination of the alliance by the legislature or the combining of the alliance with a governmental body.   

C.     At least one year prior to the expiration of an alliance administrator contract, the board may invite all interested parties, including the current administrator, to submit proposals to serve as alliance administrator for a succeeding contract period. Selection of the administrator for a succeeding contract period shall be made at least six months prior to the expiration of the current contract.   

D.     The alliance administrator shall:   

(1)     take applications for an approved health plan from small employers or a referring agent;   

(2)     establish a premium billing procedure for collection of premiums from insureds. Billings shall be made on a periodic basis, not less than monthly, as determined by the board;   

(3)     pay the member that offers an approved health plan the net premium due after deduction of reinsurance and administrative allowances;   

(4)     provide the member with any changes in the status of insureds;   

(5)     perform all necessary functions to assure that each member is providing timely payment of benefits to individuals covered under an approved health plan, including:   

(a)     making information available to insureds relating to the proper manner of submitting a claim for benefits to the member offering the approved health plan and distributing forms on which submissions shall be made; and   

(b)     making information available on approved health plan benefits and rates to insureds;   

(6)     submit regular reports to the board regarding the operation of the alliance, the frequency, content and form of which shall be determined by the board;   

(7)     following the close of each fiscal year, determine premiums of members, the expense of administration and the paid and incurred health care service charges for the year and report this information to the board and the superintendent on a form prescribed by the superintendent; and   

(8)     establish the premiums for reinsurance and the administrative charges, subject to approval of the board.   

E.     The board may require members issuing policies through the alliance to perform, subject to the oversight of the board, any or all of the administrative functions of the alliance related to enrollment, billing or other activity that members regularly perform in the normal course of business. Members shall be required to submit regular reports to the board of such activities, as specified by the board. Members performing such functions shall not be entitled to receive any portion of the administrative assessment or any other payment from the alliance for performing such services.