§33-26B-10 Plan of operation. - West Virginia Statutes

§33-26B-10. Plan of operation.

(a) The association shall submit to the commissioner a proposed plan of operation and all subsequent amendments thereto to assure the equitable, efficient administration of the association. The proposed plan of operation and any amendments thereto shall become effective upon approval by the commissioner.

(b) If the association fails to submit a suitable proposed plan of operation within one hundred and eighty days following the effective date of this article, or if at any time thereafter, the association fails to submit suitable amendments to the plan of operation within a reasonable time, the commissioner, after notice and hearing, shall promulgate by order such plan provisions as he deems necessary or appropriate. Plan provisions promulgated by the commissioner shall continue in force until modified by the commissioner or superseded by a plan or amendments thereto which has been submitted by the association and approved by the commissioner.

(c) All health maintenance organizations shall comply with the plan of operation.

(d) In addition to such requirements as are set forth elsewhere in this article, the plan of operation shall:

(1) Establish procedures for handling the assets of the association;

(2) Establish the amount and method of reimbursing members of the board of directors for reasonable expenses;

(3) Provide for regular meetings of the board of directors and establish methods by which meetings of the board of directors may be conducted, including, but not limited to, telephone conferences;

(4) Establish procedures for keeping records of all financial transactions of the association, its agents, and the board of directors;

(5) Establish criteria for board members, and procedures for selecting board members and submitting such selections to the commissioner;

(6) Establish procedures for making assessments under this article;

(7) Contain additional provisions necessary for the exercise of the association's powers and the fulfillment of the association's duties.

(e) The plan of operation may provide that any or all powers of the association, except those set forth in subsection (f), section eight of this article, and in subdivision (2), subsection (g), section eight of this article, and in section nine of this article, may be delegated to an administrator, which may be a corporation, association, or other organization, and which performs or will perform functions similar to those of the association, or its equivalent. Such a delegation shall take effect only with the approval of the commissioner, who may revoke such delegation at any time. The administrator shall be reimbursed for any payments it makes on behalf of the association and shall be paid for theservices it renders to the association. The delegation of powers to an administrator shall not absolve the association of any duty imposed upon it by this article.

(f) If the plan of operation provides for the delegation of powers to an administrator, the association shall select an administrator, with the approval of the commissioner. The selection of an administrator shall be exempt from the competitive bidding process which may apply to certain state agencies. The association shall evaluate potential administrators based upon reasonable criteria, which shall include, but not be limited to:

(1) The administrator's proven ability to manage large group health insurance plans or health maintenance organizations;

(2) The efficiency of the administrator's procedures;

(3) An estimate of the administrator's charges for services rendered to the association.