Rule 120-2-79-.19 - Contracts with Members and Participating Carriers(1) Contracts or written service agreements between the health plan purchasing cooperative and a participating carrier shall: (a) Establish, on a consistent and uniform basis, a policyholder, which shall be either the health plan purchasing cooperative or each of its members;(b) Provide that the participating carrier will issue a certificate of coverage, or equivalent document, specifying the essential features of coverage under the health benefit plan to each enrolled employee; and(c) Specify how all premiums will be transmitted, applicable penalties and grace periods for payments, and underwriting criteria or other standards pertaining to the business underwritten by such carrier in the health plan purchasing cooperative.(2) On a consistent basis for all members, contracts between the health plan purchasing cooperative and a member shall:(a) For administrative purposes, establish, on a uniform basis for each market type, either the health plan purchasing cooperative, in trust, or the member as the policyholder of the health benefit plan on behalf of eligible employees and dependents;(b) Provide that the participating carrier will issue a certificate of coverage, or equivalent document, specifying the essential features of coverage under the health benefit plan to each enrolled eligible employee;(c) Provide that the member must establish an employer-sponsored health benefit arrangement for its employees (or, in the case of an individual member, obtain coverage for himself or herself) only through health benefit plans offered by the health plan purchasing cooperative;(d) Establish applicable penalties and grace periods for a member to make premium payments to the health plan purchasing cooperative, guidelines on how all premiums will be transmitted, and standards for the collection of membership or administrative fees for the operation of the health plan purchasing cooperative; and(e) Describe the terms of membership and renewal of membership and coverage under a health benefit plan.(3) A health plan purchasing cooperative shall file with the Commissioner for approval a sample of each type of contract proposed for use with members and carriers.(4) Participating carriers shall file with the Commissioner for approval any contract or policy of insurance to be delivered to a health plan purchasing cooperative or its members as a health benefit plan or as an additional insurance benefit, unless such policy has previously been approved by the Commissioner for use. Any amendments, riders, or exclusions added to a previously approved policy or contract applicable to health plan purchasing cooperative members shall be filed for approval.Ga. Comp. R. & Regs. R. 120-2-79-.19
O.C.G.A. Secs. 33-2-9, 33-30A-5, 33-30A-9.
Original Rule entitled "Contracts with Members and Participating Carriers" adopted. F. Feb. 23, 2000; eff. Mar. 14, 2000.