Sec. 5.5. (a) If an insurer uses the services of an administrator, the insurer is responsible for:
(1) determining the:
(A) benefits;
(B) premium rates;
(C) underwriting criteria; and
(D) claims payment procedures;
that apply to the coverage; and
(2) securing reinsurance.
(b) An insurer shall provide to an administrator, with the written agreement required under section 2 of this chapter:
(1) the rules that the administrator must follow in administering the coverage, as determined under subsection (a); and
(2) the responsibilities of the administrator as to administering the coverage.
(c) An insurer that uses the services of an administrator has sole responsibility for the competent administration of benefit programs provided by the insurer.
(d) If an administrator administers benefits for more than one hundred (100) covered individuals on behalf of an insurer, the insurer shall, not less than semiannually, review the operations of the administrator. At least one (1) of the semiannual reviews must be an onsite audit of the operations of the administrator.
As added by P.L.160-2003, SEC.9.
Structure Indiana Code
Article 1. Department of Insurance
Chapter 25. Insurance Administrators
27-1-25-3. Presumptions as to Payment of Premiums and Claims
27-1-25-5.5. Insurer Responsibilities
27-1-25-6. Fiduciary Status of Administrator; Fiduciary Accounts
27-1-25-8. Administrator Compensation
27-1-25-9. Delivery of Written Communications
27-1-25-10. Notice of Relationship; Statement of Premiums or Charges
27-1-25-12.3. Resident Administrator Annual Filings
27-1-25-12.4. Denial, Suspension, or Revocation of Administrator License
27-1-25-13. Public Documents; Confidentiality; Financial Information