§58‑47‑160. Written agreement; composition; restrictions.
(a) No person may actas a TPA or service company without a written agreement between the TPA orservice company and the self‑insurer. The written agreement shall beretained by the self‑insurer and the TPA or service company for theduration of the agreement and for five years thereafter. The agreement shallcontain all provisions required by this Article, to the extent thoserequirements apply to the functions performed by the TPA or service company.
(b) Groups shall filewith the Commissioner the written agreement, and any amendments to theagreement, within 30 days after execution. Single employers shall furnish theCommissioner, upon request, the written agreement and any amendments to theagreement. The information required by this section, including any tradesecrets, shall be kept confidential; provided that the Commissioner may usethat information in any judicial or administrative proceeding institutedagainst the TPA or service company.
(c) The writtenagreement shall set forth the duties and powers of the TPA or service companyand the self‑insurer. The Commissioner shall disapprove any such writtenagreement that:
(1) Subjects the self‑insurerto excessive charges for expenses or commission.
(2) Vests in the TPA orservice company any control over the management of the affairs of the self‑insurerto the exclusion of the governing board of the self‑insurer.
(3) Is entered into withany TPA or service company if the person acting as the TPA or service company,or any of the officers or directors of the TPA or service company, is of knownbad character or has been affiliated directly or indirectly through ownership,control, management, reinsurance transactions, or other insurance or business relationshipswith any person known to have been involved in the improper manipulation ofassets, accounts, or reinsurance.
(4) Is determined by theCommissioner to contain provisions that are not fair and reasonable to the self‑insurer.
(d) The self‑insurer,TPA, or service company may, by written notice, terminate the agreement asprovided in the agreement. The self‑insurer may suspend the underwritingauthority of the TPA during the pendency of any dispute regarding the cause fortermination of the agreement. The self‑insurer shall fulfill any lawfulobligations with respect to policies affected by the agreement, regardless ofany dispute between the self‑insurer and the TPA or service company.
(e) The contract maynot be assigned in whole or part by the TPA or service company without priorapproval by the governing board of the self‑insurer and the Commissioner.(1997‑362, s. 3.)
§58‑47‑160. Written agreement; composition; restrictions.
(a) No person may actas a TPA or service company without a written agreement between the TPA orservice company and the self‑insurer. The written agreement shall beretained by the self‑insurer and the TPA or service company for theduration of the agreement and for five years thereafter. The agreement shallcontain all provisions required by this Article, to the extent thoserequirements apply to the functions performed by the TPA or service company.
(b) Groups shall filewith the Commissioner the written agreement, and any amendments to theagreement, within 30 days after execution. Single employers shall furnish theCommissioner, upon request, the written agreement and any amendments to theagreement. The information required by this section, including any tradesecrets, shall be kept confidential; provided that the Commissioner may usethat information in any judicial or administrative proceeding institutedagainst the TPA or service company.
(c) The writtenagreement shall set forth the duties and powers of the TPA or service companyand the self‑insurer. The Commissioner shall disapprove any such writtenagreement that:
(1) Subjects the self‑insurerto excessive charges for expenses or commission.
(2) Vests in the TPA orservice company any control over the management of the affairs of the self‑insurerto the exclusion of the governing board of the self‑insurer.
(3) Is entered into withany TPA or service company if the person acting as the TPA or service company,or any of the officers or directors of the TPA or service company, is of knownbad character or has been affiliated directly or indirectly through ownership,control, management, reinsurance transactions, or other insurance or business relationshipswith any person known to have been involved in the improper manipulation ofassets, accounts, or reinsurance.
(4) Is determined by theCommissioner to contain provisions that are not fair and reasonable to the self‑insurer.
(d) The self‑insurer,TPA, or service company may, by written notice, terminate the agreement asprovided in the agreement. The self‑insurer may suspend the underwritingauthority of the TPA during the pendency of any dispute regarding the cause fortermination of the agreement. The self‑insurer shall fulfill any lawfulobligations with respect to policies affected by the agreement, regardless ofany dispute between the self‑insurer and the TPA or service company.
(e) The contract maynot be assigned in whole or part by the TPA or service company without priorapproval by the governing board of the self‑insurer and the Commissioner.(1997‑362, s. 3.)
§58‑47‑160. Written agreement; composition; restrictions.
(a) No person may actas a TPA or service company without a written agreement between the TPA orservice company and the self‑insurer. The written agreement shall beretained by the self‑insurer and the TPA or service company for theduration of the agreement and for five years thereafter. The agreement shallcontain all provisions required by this Article, to the extent thoserequirements apply to the functions performed by the TPA or service company.
(b) Groups shall filewith the Commissioner the written agreement, and any amendments to theagreement, within 30 days after execution. Single employers shall furnish theCommissioner, upon request, the written agreement and any amendments to theagreement. The information required by this section, including any tradesecrets, shall be kept confidential; provided that the Commissioner may usethat information in any judicial or administrative proceeding institutedagainst the TPA or service company.
(c) The writtenagreement shall set forth the duties and powers of the TPA or service companyand the self‑insurer. The Commissioner shall disapprove any such writtenagreement that:
(1) Subjects the self‑insurerto excessive charges for expenses or commission.
(2) Vests in the TPA orservice company any control over the management of the affairs of the self‑insurerto the exclusion of the governing board of the self‑insurer.
(3) Is entered into withany TPA or service company if the person acting as the TPA or service company,or any of the officers or directors of the TPA or service company, is of knownbad character or has been affiliated directly or indirectly through ownership,control, management, reinsurance transactions, or other insurance or business relationshipswith any person known to have been involved in the improper manipulation ofassets, accounts, or reinsurance.
(4) Is determined by theCommissioner to contain provisions that are not fair and reasonable to the self‑insurer.
(d) The self‑insurer,TPA, or service company may, by written notice, terminate the agreement asprovided in the agreement. The self‑insurer may suspend the underwritingauthority of the TPA during the pendency of any dispute regarding the cause fortermination of the agreement. The self‑insurer shall fulfill any lawfulobligations with respect to policies affected by the agreement, regardless ofany dispute between the self‑insurer and the TPA or service company.
(e) The contract maynot be assigned in whole or part by the TPA or service company without priorapproval by the governing board of the self‑insurer and the Commissioner.(1997‑362, s. 3.)
