18 Del. Admin. Code § 1406-7.0
Current through Register Vol. 28, No. 5, November 1, 2024
Section 1406-7.0 - Responsibilities of the Insurer7.1 If an insurer utilizes the services of an administrator, the insurer shall be responsible for determining the benefits, premium rates, underwriting criteria and claims payment procedures applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters shall be provided, in writing, by the insurer to the administrator. The responsibilities of the administrator as to any of these matters shall be set forth in the written agreement between the administrator and the insurer.7.2 It is the sole responsibility of the insurer to provide for competent administration of its programs.7.3 In cases where an administrator administers benefits for more than one hundred certificate holders on behalf of an insurer, the insurer shall, at least semiannually, conduct a review of the operations of the administrator, which may be conducted on-site or by virtual means.7.4 For purposes of this section, "insurer" means a licensed insurance company, prepaid hospital or medical care plan, a health maintenance organization or a multiple employer welfare arrangements (MEWAs).18 Del. Admin. Code § 1406-7.0
27 DE Reg. 342 (11/1/2023) (final)