Title 33, Chapter 30A, Section 4
( 33-30A-4)
(a)(1) Membership in a health plan purchasing cooperative shall be
voluntary. (2) A purchasing cooperative shall accept for membership in the
cooperative any eligible small employer which agrees to pay the
membership fee and a premium for coverage through the purchasing
cooperative and which abides by the bylaws and rules of the
purchasing cooperative. (3) A purchasing cooperative may, at its option, accept for
membership in the cooperative any otherwise eligible employer
which does not qualify as a small employer because it employed
more than 50 eligible employees during 50 percent or more of its
working days during the previous calendar quarter. (4) A purchasing cooperative may, at its option, accept for
membership in the cooperative any otherwise eligible employer
which does not qualify as a small employer because it is an
individual or sole proprietor. If a purchasing cooperative
chooses to accept such employers, the purchasing cooperative may
not discriminate in the acceptance process based upon health
status. (5) A purchasing cooperative and its contracted carriers shall comply with the small group health insurance rating requirements provided for in Code Section 33-30-12. (b) Each purchasing cooperative shall have the following powers,
duties, and responsibilities: (1) Establishing and clearly defining the conditions of membership
and participation in the purchasing cooperative. Each cooperative
shall establish conditions for small employers which must include,
but need not be limited to, assurance that the group is a valid
small employer and is not formed for the purpose of securing
health benefit coverage and assurance that the individuals in the
small employer group are employees and have not been added for the
purpose of securing health benefit coverage. A purchasing
cooperative shall not establish or enforce membership conditions
or participation requirements, bylaws, rules, or policies,
financial or otherwise, which have the effect of excluding or
including membership on the basis of health status of otherwise
eligible individuals or other risk characteristics, including, but
not limited to, industry type, occupation, experience, age,
gender, family composition, education, avocation, or income; nor
shall a purchasing cooperative require any small employer,
employee, self-employed individual, or dependent to subscribe to
limited accident and sickness insurance policies, products, or
services not related to health care; (2) Providing to cooperative members clear, standardized
information on each health benefit plan or other coverage offered
by carriers through the cooperative to cooperative members,
including information on price, enrollee costs, quality, patient
satisfaction, enrollment, and enrollee responsibilities and
obligations and providing health benefit plan and other insurance
comparison sheets in accordance with department rule;
(3) Annually offering to all members of the cooperative all health
benefit plans and other insurance offered by carriers which meet
the requirements of this chapter and which submit a responsive
proposal as to information necessary for health benefit plans and
other insurance comparison sheets and providing assistance to
cooperative members in selecting and obtaining coverage with
carriers that meet those requirements. A purchasing cooperative
shall, whenever feasible, contract with multiple, unaffiliated
carriers to offer health benefit plans and other insurance to its
members. A purchasing cooperative may selectively contract with
carriers based on the quality and cost effectiveness of services
and other factors deemed to be relevant by the purchasing
cooperative; (4) Requesting proposals for health benefit plans and other
insurance from carriers; (5) Establishing administrative procedures and accounting
procedures consistent with generally accepted accounting
principles for the operation of the cooperative and members'
services, preparing an annual cooperative budget, and preparing
annual program and fiscal reports on cooperative operations as
required by this chapter; (6) Developing and implementing a marketing plan to publicize the
cooperative to potential members; (7) Developing grievance procedures to be used in resolving
disputes between members and the cooperative and disputes between
carriers and the cooperative. Any member of, or carrier that
serves, a cooperative shall not be prohibited from filing
grievances directly with the department; (8) Ensuring that carriers have grievance procedures to be used in
resolving disputes with members of the cooperative. A member may
appeal to the cooperative any grievance that is not resolved by
the carrier; (9) Maintaining all records, reports, and other information
required by this chapter or by department rule or other applicable
laws; (10) Contracting with qualified, independent third parties for any
services necessary to carry out the powers and duties required by
this chapter; (11) Assisting agents or employees in enrolling eligible members,
employees, and dependents in selected health benefit plans and
other insurance and services, establishing procedures for
collecting premiums, collecting premiums, appropriately
distributing collected premiums to participating carriers, and
paying third-party contractors. The cooperative shall pay
participating carriers their contracting premium amounts on a
prepaid monthly basis or as otherwise mutually agreed upon; and (12) Working with participating carriers to establish standard
criteria for selecting participating licensed agents. (c) Each cooperative may set and collect reasonable fees for
membership in the cooperative which may finance reasonable and
necessary costs incurred in administering the cooperative. Any such
fee must be clearly identified and not inconsistent with the
provisions of paragraph (1) of subsection (b) of this Code section. (d)(1) Each cooperative shall provide semiannual financial
statements and annual reports regarding cooperative programs and
operations to the Commissioner. (2) Each cooperative shall provide for annual independent audits
by a certified public accountant and make reports of such audits
available to the Commissioner and the public. (3) Each purchasing cooperative shall file annually with the
Commissioner, at such time and in such form and manner as
specified by the Commissioner, evidence of adequate security and
prudence in account, premium collection, and the handling and
transfer of moneys and evidence of compliance with the provisions
of this chapter, including a description of the specific services
provided by the purchasing cooperative. (e) Each purchasing cooperative shall maintain a trust account or
accounts for the deposit of any premium moneys collected. (f) Each purchasing cooperative shall disclose to the Commissioner
any oral or written agreements made prior to its authorization as a
purchasing cooperative. (g) Any act of selling health benefit plans or other insurance shall
be in accordance with Chapter 23 of this title. |