Section 27-20.7-1. – Short title.

§ 27-20.7-1. Short title. This chapter shall be known as “The Third Party Health Insurance Administrators Act.” History of Section.P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.

Section 27-20.7-10. – Notice and disclosure of charges and fees.

§ 27-20.7-10. Notice and disclosure of charges and fees. (a) When the services of an administrator are utilized, the administrator shall provide a written notice approved by the insurer to covered individuals advising them of the identity of, and relationship among, the administrator, the policyholder and the insurer. (b) When an administrator collects funds, the […]

Section 27-20.7-11. – Delivery of materials.

§ 27-20.7-11. Delivery of materials. Any policies, certificates, booklets, termination notices or other written communications delivered by the insurer to the administrator for delivery to insured parties or covered individuals shall be delivered by the administrator promptly after receipt of instructions from the insurer to deliver them. History of Section.P.L. 2001, ch. 83, § 1; […]

Section 27-20.7-12. – Certificate of authority required.

§ 27-20.7-12. Certificate of authority required. (a) No person shall act as, or offer to act as, or hold himself or herself out to be an administrator in this state without a valid certificate of authority as an administrator issued by the commissioner. (b) Applicants to be an administrator shall make an application to the […]

Section 27-20.7-13. – Waiver of application for certification.

§ 27-20.7-13. Waiver of application for certification. Upon request from an administrator, the commissioner may waive the application requirements of § 27-20.7-12(b) if the administrator has a valid certificate of authority as an administrator issued in a state which has standards for administrators that are at least as stringent as those contained in the model […]

Section 27-20.7-14. – Annual report and filing fee.

§ 27-20.7-14. Annual report and filing fee. (a) Each administrator shall file an annual report for the preceding calendar year with the commissioner on or before March 1 of each year, or within any extension of time for filing as the commissioner for good cause may grant. The report shall be in the form and […]

Section 27-20.7-15. – Grounds for suspension or revocation of certificate of authority.

§ 27-20.7-15. Grounds for suspension or revocation of certificate of authority. (a) The certificate of authority of an administrator shall be suspended or revoked if the commissioner finds that the administrator is: (1) In an unsound financial condition; (2) Using any methods or practices in the conduct of its business so as to render its […]

Section 27-20.7-16. – Unauthorized third party administrator business.

§ 27-20.7-16. Unauthorized third party administrator business. The unauthorized conduct of the business of an administrator shall be treated as unauthorized insurance business and shall be subject to the same penalties as provided in § 27-16-1.3 for violation of § 27-16-1.2. History of Section.P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.

Section 27-20.7-2. – Definitions.

§ 27-20.7-2. Definitions. As used in this chapter, the following terms have the following meanings: (1) “Administrator” means a person who directly or indirectly solicits or effects coverage of, underwrites, collects charges or premiums from, or adjusts or settles claims on residents of this state, or residents of another state from offices in this state, […]

Section 27-20.7-3. – Written agreement.

§ 27-20.7-3. Written agreement. (a) No administrator shall act as an administrator without a written agreement between the administrator and the insurer, and the written agreement shall be retained as part of the official records of both the insurer and the administrator for the duration of the agreement and for five (5) years after this. […]

Section 27-20.7-4. – Payments to administrator.

§ 27-20.7-4. Payments to administrator. If an insurer utilizes the services of an administrator, the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured party shall be deemed to have been received by the insurer, and the payment of return premiums or claim payments forwarded by […]

Section 27-20.7-5. – Maintenance of records.

§ 27-20.7-5. Maintenance of records. (a) Every administrator shall maintain and make available to the insurer complete books and records of all transactions performed on behalf of the insurer. The books and records shall be maintained in accordance with prudent standards of insurance record keeping and must be maintained for a period of not less […]

Section 27-20.7-6. – Approval of advertising.

§ 27-20.7-6. Approval of advertising. An administrator may use only advertising pertaining to the business underwritten by an insurer that has been approved in writing by the insurer in advance of its use. History of Section.P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.

Section 27-20.7-7. – Responsibilities of the insurer.

§ 27-20.7-7. Responsibilities of the insurer. (a) If an insurer utilizes the services of an administrator, the insurer shall be responsible for determining the benefits, premium rates, underwriting criteria and claims payment procedures applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters must be provided, in writing, by […]

Section 27-20.7-8. – Premium collection and payment of claims.

§ 27-20.7-8. Premium collection and payment of claims. (a) All insurance charges or premiums collected by an administrator on behalf of or for an insurer or insurers, and the return of premiums received from that insurer or insurers, shall be held by the administrator in a fiduciary capacity. The funds shall be immediately remitted to […]

Section 27-20.7-9. – Compensation to the administrator.

§ 27-20.7-9. Compensation to the administrator. (a) An administrator shall not enter into an agreement or understanding with an insurer in which the effect is to make the amount of the administrator’s commissions, fees, or charges contingent upon savings effected in the adjustment, settlement and payment of losses covered by the insurer’s obligations. This provision […]