376.1084. Insurer responsible for benefits and underwriting practices--insurer to conduct review of administrator, when. - Missouri Statutes

Insurer responsible for benefits and underwriting practices--insurerto conduct review of administrator, when.

376.1084. 1. If an insurer uses the services of anadministrator, the insurer shall be responsible for determiningthe benefits, premium rates, underwriting criteria and claimspayment procedures applicable to such coverage and for securingreinsurance, if any. The rules pertaining to these matters shallbe provided, in writing, by the insurer to the administrator.The responsibilities of the administrator as to any of thesematters shall be set forth in the written agreement between theadministrator and the insurer.

2. It is the sole responsibility of the insurer to providefor competent administration of its programs.

3. In cases where an administrator administers benefits formore than one hundred certificate holders on behalf of aninsurer, the insurer shall, at least semiannually, conduct areview of the operations of the administrator. At least one suchreview shall be an on-site audit of the operations of theadministrator.

(L. 1993 H.B. 709 § 46)