376.964. Board, powers and duties — including providing for issuing policies and reinsuring risks — staff appointment — rulemaking authority.

511 words·~2 min read·/mo/chapter-376/376-964

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376.964. Board, powers and duties — including providing for issuing policies and reinsuring risks — staff appointment — rulemaking authority. — The board of directors and administering insurers of the pool shall have the general powers and authority granted under the laws of this state to insurance companies licensed to transact health insurance as defined in section 376.960 , and, in addition thereto, the specific authority to:

(1)Enter into contracts as are necessary or proper to carry out the provisions and purposes of sections 376.960 to 376.989 , including the authority, with the approval of the director, to enter into contracts with similar pools of other states for the joint performance of common administrative functions, or with persons or other organizations for the performance of administrative functions;

(2)Sue or be sued, including taking any legal actions necessary or proper for recovery of any assessments for, on behalf of, or against pool members;

(3)Take such legal actions as necessary to avoid the payment of improper claims against the pool or the coverage provided by or through the pool;

(4)Establish appropriate rates, rate schedules, rate adjustments, expense allowances, agents' referral fees, claim reserve formulas and any other actuarial function appropriate to the operation of the pool. Rates shall not be unreasonable in relation to the coverage provided, the risk experience and expenses of providing the coverage. Rates and rate schedules may be adjusted for appropriate risk factors such as age and area variation in claim costs and shall take into consideration appropriate risk factors in accordance with established actuarial and underwriting practices;

(5)Assess members of the pool in accordance with the provisions of this section, and to make advance interim assessments as may be reasonable and necessary for the organizational and interim operating expenses. Any such interim assessments are to be credited as offsets against any regular assessments due following the close of the fiscal year;

(6)Prior to January 1, 2014, issue policies of insurance in accordance with the requirements of sections 376.960 to 376.989 . In no event shall new policies of insurance be issued on or after January 1, 2014;

(7)Appoint, from among members, appropriate legal, actuarial and other committees as necessary to provide technical assistance in the operation of the pool, policy or other contract design, and any other function within the authority of the pool;

(8)Establish rules, conditions and procedures for reinsuring risks of pool members desiring to issue pool plan coverages in their own name. Such reinsurance facility shall not subject the pool to any of the capital or surplus requirements, if any, otherwise applicable to reinsurers;

(9)Negotiate rates of reimbursement with health care providers on behalf of the association and its members;

(10)Administer separate accounts to separate federally defined eligible individuals and trade act eligible individuals who qualify for plan coverage from the other eligible individuals entitled to pool coverage and apportion the costs of administration among such separate accounts.

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(L. 1990 H.B. 998 § 2 subsec. 6, A.L. 2007 H.B. 818, A.L. 2013 S.B. 262)