§ 58-56-26. Responsibilities of the insurer. - North Carolina Statutes

§ 58‑56‑26. Responsibilities of the insurer.

(a)        If an insurer usesthe services of a TPA, the insurer is responsible for determining the benefits,premium rates, underwriting criteria, and claims payment procedures applicableto the coverage and for securing reinsurance, if any. The rules pertaining tothese matters must be provided, in writing, by the insurer to the TPA. Theresponsibilities of the TPA as to any of these matters shall be set forth inthe agreement between the TPA and the insurer.

(b)        It is the soleresponsibility of the insurer to provide for competent administration of itsprograms.

(c)        In cases where aTPA administers benefits for more than 100 certificate holders on behalf of aninsurer, the insurer shall, at least semiannually, conduct a review of theoperations of the TPA. At least one semiannual review shall be an on‑siteaudit of the operations of the TPA. On July 1, 2010, and annually thereafter,every insurer shall file with the Commissioner a certification of completion ofthe audits as required by this subsection and performed during the previouscalendar year, in the format, content, and manner as specified by theCommissioner. The insurer shall maintain in its corporate records documentationof the audits conducted to support its certification of audits for a period offive years or, if a domestic insurer, until the completion of the nextquinquennial examination.

(d)        The Commissionermay adopt rules necessary to implement, administer, and enforce the provisionsof this section.  (1991,c. 627, s. 1; 2009‑382, ss. 12, 13.)