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RSA 420-M:7 · Powers and Duties of Purchasing Alliances; Restrictions on Purchasing Alliances
420-M:7 Powers and Duties of Purchasing Alliances; Restrictions on Purchasing Alliances. –
Copy linkEstablish administrative and accounting procedures for operating the alliance, for providing services to member employers and enrollees, and for preparing an annual budget;
Copy linkDevelop standard enrollment procedures for enrolling employers and their eligible employees and dependents;
Copy linkEstablish conditions of participation for small employers that conform to the requirements of RSA 420-G and include, but are not limited to, the following:
Copy linkAssurances that the member employer is an employer group and is not formed for the purpose of securing health benefits coverage; and
Copy linkPrepayment of premiums or other mechanisms to assure that payment will be made for coverage;
Copy linkEstablish membership criteria that allow any employer to participate in the alliance or that limit participation in the alliance to employers that are members of or affiliated with an association, trade group, or other entity that has been in existence for at least 10 years and was established and maintained for purposes other than the provision of health coverage;
Copy linkProvide that each eligible employee is permitted to enroll in any health benefit plan offered by any participating carrier so long as the health benefit plan provides coverage where he or she works or lives;
Copy linkDevelop and make available a list of objective criteria that shall be met by a participating carrier offering coverage to alliance members;
Copy linkProvide to alliance members clear, standardized information on the health benefit plan including information on:
Copy linkTransmit enrollment and eligibility information to participating carriers on a timely basis;
Copy linkSpecify in contracts with participating carriers how all premiums shall be transmitted and the frequency of that transmission and how penalties and grace periods on late payments of premiums shall be calculated;
Copy linkHave a fiduciary duty with respect to all moneys received or owed to it to assure payments of its obligations and a full accounting to its members and the commissioner; and
Copy linkSubmit to the commissioner quarterly financial statements, annual reports, and proposed material changes in the policy and/or operations or the business plan.
Copy linkReceive, review, and act on grievances against participating carriers by member employers or enrollees;
Copy linkMaintain a trust account or accounts for deposit of all moneys received and collected for the operation of the alliance;
Copy linkEstablish procedures and mechanisms for billing and collection of premiums from member employers, including collection of any share of the premium paid by employee enrollees;
Copy linkReview information and recommendations from consumers, employers, participating carriers, or health care providers and other sources, and issue periodic reports or recommendations to the commissioner to improve the delivery of health services and the purchasing of health coverage;
Copy linkDevelop model contracts that describe for potential contractors the requirements of the alliance and provide a copy of the contract to interested carriers;
Copy linkA provision stating that, for administrative purposes, the alliance shall be the policyholder or contract holder of the health benefit plan on behalf of member employers, their eligible employees, and eligible dependents; and
Copy linkA provision stating that the participating carrier shall issue a certificate of coverage, or equivalent document, specifying the essential features of the health benefit plan's coverage to each enrolled eligible employee;
Copy linkUndertake any activity necessary to administer the alliance, including marketing and publicizing the alliance, and assuring that participating carriers, contractors, participating employers, and enrollees are in compliance with alliance requirements;
Copy linkEstablish contracts with participating carriers to provide health coverage to alliance members;
Copy linkContract with qualified, independent third parties for services necessary to carry out the powers and duties of the alliance;
Copy linkAppoint advisory committees, as necessary, to provide technical assistance in the operation of the program and in carrying out the purposes of this chapter;
Copy linkAssess member employers a fee for costs incurred or anticipated in connection with the operation of the alliance;
Copy linkRequire as a condition of membership that employers include a minimum percentage of employees in coverage purchased through the alliance;
Copy linkReject or allow a carrier to reject an employer from membership or drop or allow a carrier to drop a member employer if the member fails to pay premiums or engages in fraud or material misrepresentation in connection with a health benefit plan purchased through the alliance;
Copy linkContract with licensed insurance agents or brokers to market and service coverage made available through the alliance to its members. Compensation for agents and brokers shall not vary based on the actual or expected health status or medical utilization of the group to which coverage is sold;
Copy linkDefine a set of standardized requirements that the alliance shall use to purchase insurance from a carrier;
Copy linkRequire that member employers and their eligible employees continue to pay administrative fees that are part of the contract with the alliance if a member employer or enrollee cancels prior to completion of a contract period or membership period established by the alliance;
Copy linkNegotiate the premium rates charged for coverage offered through the alliance and, for small employer members, ensure that rates are consistent with the rating restrictions contained in RSA 420-G;
Copy linkRequest such information from participating carriers as is necessary to carry out the powers and duties of this chapter;
Copy linkSue or be sued, including taking action necessary for securing legal remedies on behalf of the alliance, member employers, or enrollees;
Copy linkApply for loans or loan guarantees from the New Hampshire business finance authority for the purpose of funding startup costs;
Copy linkReceive and accept loans, grants, funds, or anything of value from a public or private entity including:
Copy linkExercise all powers reasonably necessary to carry out the powers granted and duties imposed under this chapter; and
Copy linkEnter into all other contracts as are necessary to carry out the powers and duties of the alliance.
Copy linkPurchase health care services directly, assume risk for the cost or provision of health care services, or otherwise contract with health care providers for the provision of health care services to enrollees.
Copy linkExclude from membership in the alliance an employer, eligible employee, or eligible dependent of an eligible employee who meets the alliance's membership criteria and who agrees to pay fees for membership and the premium for health coverage through the alliance and who abides by the bylaws and rules of the alliance.
Copy linkAs a condition of membership, require an employer, eligible employee, or eligible dependent to subscribe to limited health coverage or non-health coverage related products or services.
Copy linkEngage in any act or practice that results in the selection of member employers and enrollees based on industry type, experience, gender, family status, education, health status, income, employer size, or other factors related to the risk profile of the group.
Copy linkRequire or take any action inconsistent or in conflict with state laws or regulations. Source. 2010, 346:1. 2011, 155:1, eff. Aug. 7, 2011.
Copy linkSource note
Source. 2010, 346:1. 2011, 155:1, eff. Aug. 7, 2011.
Source history
- 2010, 346:1
- 2011, 155:1, eff. Aug. 7, 2011