§ 23-92-507. Gag clauses prohibited
(a) The prohibitions under § 23-99-407 apply to participation contracts between pharmacy benefits managers and pharmacists or pharmacies providing prescription drug coverage for health benefit plans. (b) A pharmacy or pharmacist may provide to an insured information regarding the insured’s total cost for pharmacist services for a prescription drug. (c) A pharmacy or pharmacist shall […]
§ 23-92-508. Enforcement
(a) The Insurance Commissioner shall enforce this subchapter. (b) (1) The commissioner may examine or audit the books and records of a pharmacy benefits manager providing claims processing services or other prescription drug or device services for a health benefit plan to determine if the pharmacy benefits manager is in compliance with this subchapter. (2) […]
§ 23-92-412. Penalties
(a) Any person who engages in the business of a professional employer organization or acts as a professional employer organization without first procuring a license or who otherwise violates any of the provisions under this subchapter shall be liable for a civil penalty of not less than two hundred fifty dollars ($250) nor more than […]
§ 23-92-413. Nondisclosure of proprietary information
(a) (1) Professional employer organizations and professional employer organization groups are required under this subchapter to file with the Insurance Commissioner certain proprietary material, including financial records and financial information and client lists, the disclosure of which would give advantage to competitors. (2) (A) The commissioner shall not consider proprietary material under this subchapter to […]
§ 23-92-206. Collection of premiums, etc. — Deposits and withdrawals
(a) An administrator is a fiduciary in collecting or returning premiums or charges for the party with whom it has a written agreement for administrative services. (b) Funds collected by the administrator shall be immediately remitted to the person entitled to the funds or deposited in a separately identifiable bank account which shall be established […]
§ 23-92-414. Employer service assurance organization affidavit
(a) The Insurance Commissioner may provide by rule for the acceptance of an employer service assurance organization affidavit provided on behalf of a professional employer organization in lieu of the requirements under §§ 23-92-404 — 23-92-406 and 23-92-408 and the fees provided for in § 23-92-407. (b) The fee for filing an employer service assurance […]
§ 23-92-207. Books and records
(a) Every administrator shall maintain at its principal administrative office for the duration of the written agreement referred to in § 23-92-202 and five (5) years thereafter adequate books and records of all transactions between it, self-insured plans, trusts, and covered individuals. These books and records shall be maintained in accordance with prudent standards of […]
§ 23-92-415. Licensing of employer service assurance organizations
(a) (1) No employer service assurance organization shall provide any service relating to the regulation of professional employer organizations, and no state agency, professional employer organization, or insurer shall utilize the services of the organization for those purposes unless the organization has obtained a license from the Insurance Commissioner. (2) No state agency, professional employer […]
§ 23-92-208. Compensation
The compensation for an administrator may be based on: (1) Premiums or charges collected; (2) The number of claims paid or processed; or (3) Some other fair and equitable basis provided by the contract.
§ 23-92-416. Employer service assurance organizations — Prohibited activities
(a) No employer service assurance organization shall attempt to monopolize or to combine or conspire with any other person to monopolize any market or make any arrangement with any professional employer organization, employer service assurance organization, or other person that has the purpose or effect of unreasonably restraining trade or of substantially lessening competition in […]