Administration of pool insurance program
(1) Except as provided in subsection (4) of this section, the Oregon Medical Insurance Pool Board shall select an insurer or insurers through a competitive bidding process to administer the insurance program or components of the insurance program. The board shall evaluate bids submitted based on criteria established by the board that include but are not limited to:
(a) The insurer’s proven ability to handle individual medical insurance.
(b) The efficiency of the insurer’s claim paying procedures.
(c) An estimate of total charges for administering the plan.
(d) The insurer’s ability to administer the pool in a cost-effective manner.
(2)(a) The administering insurer shall serve for a period of three years subject to removal for cause.
(b) At least one year prior to the expiration of each three-year period of service by an administering insurer, the board shall invite all insurers, including the current administering insurer, to submit bids to serve as the administering insurer for the succeeding three-year period. Selection of the administering insurer for the succeeding period shall be made at least six months prior to the end of the current three-year period.
(3) The administering insurer shall be responsible for one or more of the following:
(a) Performing eligibility and administrative claims payment functions relating to the pool.
(b) Establishing a premium billing procedure for collection of premiums from insured persons on a periodic basis as determined by the board.
(c) Performing all necessary functions to assure timely payment of benefits to covered persons under the pool including:
(A) Making available information relating to the proper manner of submitting a claim for benefits and distributing forms upon which submission shall be made.
(B) Evaluating the eligibility of each claim for payment.
(d) Submitting regular reports to the board regarding the operation of the pool. The frequency, content and form of the report shall be as determined by the board.
(e) Following the close of each calendar year, determining net written and earned premiums, the expense of administration and the paid and incurred losses for the year and reporting this information to the board on a form prescribed by the board.
(f) Being paid as provided in the plan of operation for its expenses incurred in the performance of its services.
(4) The board may contract with third party administrators or other vendors to provide services described in subsection (5) of this section that are in addition to or that replace services provided by the administering insurer.
(5) A third party administrator or vendor may provide services that include but are not limited to:
(a) Any or all of the services provided by an administering insurer.
(b) Disease case management.
(c) Direct provider or provider network contracts.
(d) Pharmacy benefit management. [1987 c.838 §6; 1989 c.838 §12; 2005 c.635 §4]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent. Currency Information