2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 54 - Medical Insurance Pool › Section 59A-54-11 - Pool administrator; selection; duties.

A. The board shall select a pool administrator through a competitive bidding process. The board shall evaluate bids based on criteria established by the board, which shall include:
(1) proven ability to handle accident and health insurance;
(2) efficiency of claim paying procedures;
(3) an estimate of total charges for administering the plan; and
(4) ability to administer the pool in a cost-efficient manner.
B. The pool administrator shall serve for a period not to exceed that provided in Subsection B of Section 13-1-150 NMSA 1978, subject to removal for cause. At least one year prior to the expiration of the pool administrator's contract, the board shall invite all interested parties, including the current administrator, to submit bids to serve as the pool administrator for the succeeding contract period. Selection of the administrator for a succeeding period shall be made at least six months prior to the expiration of the pool administrator's current contract.
C. The pool administrator shall:
(1) perform all eligibility and administrative claim payment functions relating to the pool;
(2) establish a premium billing procedure for collection of premiums from insured persons. Billings shall be made on a periodic basis, not less than monthly, as determined by the board;
(3) perform all necessary functions to assure timely payment of benefits to persons covered under the pool, including:
(a) making information available relating to the proper manner of submitting a claim for benefits to the pool and distributing forms upon which submission shall be made; and
(b) evaluating the eligibility of each claim for payment by the pool;
(4) submit 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; and
(5) following the close of each fiscal year, determine net written and earned premiums, the expense of administration and the paid and incurred losses for the year and report this information to the board and the superintendent on a form prescribed by the superintendent.
D. The administrator shall be paid as provided in the contract negotiated pursuant to the process for selection of the administrator established by the board.
History:
1978 Comp., § 59A-54-11, enacted by Laws 1987, ch. 154, § 11; 1991, ch. 200, § 8; 2021, ch. 108, § 33.
ANNOTATIONS
The 2021 amendment,
effective July 1, 2021, revised the service period for a pool administrator, conforming the administrator's contract period to requirements of the state procurement code; and in Subsection B, after "serve for a period", deleted "of three years" and added "not to exceed that provided in Subsection B of Section 13-1-150 NMSA 1978", after "prior to the expiration of", deleted "each three year period of service", after "the pool", deleted "administrator" and added "administrator's contract", after "succeeding", deleted "three-year" and added "contract", and after "expiration of", deleted "a three-year period of service by a pool administrator" and added "the pool administrator's current contract".
The 1991 amendment,
effective June 14, 1991, rewrote Subsection D, which read "The administrator shall be paid as provided in the plan of operation for expenses incurred in the performance of services".