2018 Wyoming Statutes
TITLE 26 - INSURANCE CODE
CHAPTER 43 - HEALTH CARE
ARTICLE 1 - WYOMING HEALTH INSURANCE POOL ACT
SECTION 26-43-104 - Administrator.
26-43-104. Administrator.
(a) The board shall select an insurer, insurers or a third party administrator or administrators through a competitive bidding process to administer the pool. The board shall evaluate bids based on criteria established by the board which shall include but are not limited to:
(i) The proven ability of the administrator to handle individual accident and health insurance;
(ii) The efficiency of the claim paying procedures of the administrator;
(iii) An estimate of total charges for administering the plan;
(iv) The ability of the administrator to administer the pool in a cost efficient manner.
(b) The administrator shall serve for a period determined by the board of not less than three (3) years and not more than five (5) years and is subject to removal for cause. At least one (1) year prior to the expiration of the period of service by an administrator, the board shall invite all insurers, including the current administrator to submit bids to serve as the administrator for the succeeding period. Selection of the administrator for the succeeding period shall be made at least six (6) months prior to the end of the current period.
(c) The administrator shall:
(i) Perform all eligibility and administrative claims payment functions relating to the pool;
(ii) Establish a premium billing procedure for collection of premiums from insureds. Billings shall be made periodically as determined by the board;
(iii) Perform all necessary functions to assure timely payment of benefits to covered persons under the pool including but not limited to:
(A) Making available information relating to the proper manner of submitting a claim for benefits to the pool and distributing forms upon which submission is made;
(B) Evaluating the eligibility of each claim for payment by the pool.
(iv) Submit regular reports to the board regarding the pool operation. The board shall determine the frequency, content and form of the report;
(v) Determine net written and earned premiums, the expense of administration and the paid and incurred losses for the year and report the information to the board and the department on a form and in the manner prescribed by the commissioner;
(vi) Receive payment as provided in the plan of operation for its expenses incurred in the performance of its services.
