2013 Wisconsin Statutes & Annotations
149. Health insurance risk-sharing plans.
149.43 Duties of authority.
149.43 Duties of authority. In addition to all other duties imposed under this chapter, the authority shall do all of the following:
(1) Adopt policies for the administration of this chapter.
(2) Contract with the plan administrator under s. 149.16, 2003 stats., in the manner required under 2005 Wisconsin Act 74, section 165 (1) (b) until the end of the contract term.
(3) Establish the authority's annual budget and monitor the fiscal management of the authority.
(4) Beginning on July 1, 2006, do, or contract with another person to do, all of the following:
(a) Perform all eligibility and administrative claims payment functions relating to the plan.
(b) Establish a premium billing procedure for collection of premiums from insured persons. Billings shall be made on a periodic basis as determined by the authority.
(c) Perform all necessary functions to assure timely payment of benefits to covered persons 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 30 days after receiving a properly completed and executed proof of loss whether the claim is accepted, rejected, or compromised.
(5) Seek to qualify or maintain the plan as a state pharmacy assistance program, as defined in 42 CFR 423.464.
(6) Annually submit a report to the legislature under s. 13.172 (2) and to the governor on the operation of the plan.
History: 2005 a. 74; 2013 a. 20.
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