Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-79 - HEALTH PLAN PURCHASING COOPERATIVES
Rule 120-2-79-.07 - Maintenance of Information; Books and Records; Annual Report to the Carrier(s); Return Credits

(1) Every health plan purchasing cooperative shall maintain at its principal administrative office for the duration of the written agreement referred to in § 120-2-79-.06 and five years thereafter books and records of all transactions between it, carriers and insured persons. The Commissioner shall have access to such books and records for the purpose of examination, audit and inspection. Any trade secrets contained therein, including but not limited to the identity and addresses of policyholders and certificate holders, shall be confidential, except the Commissioner may use such information in any proceedings instituted against the health plan purchasing cooperative. The participating carrier shall retain the right to continuing access to such books and records of the health plan purchasing cooperative sufficient to permit the carrier to fulfill all of its contractual obligations to insured persons, subject to any restrictions in the written agreement between the carrier and health plan purchasing cooperative on the proprietary rights of the parties in such books and records.

(2) Health plan purchasing cooperatives shall maintain detailed books and records that reflect all transactions specifically in regard to premiums, premium taxes, agent commissions, fees, contributions received and deposited.

(3) The detailed preparation, journalizing, and posting of such books and records shall be made in accordance with the terms and conditions of the service agreement or contract between the health plan purchasing cooperative and the carrier, and in accordance with the "Employee Retirement and Income Security Act of 1974," 88 Stat. 829, 29 U.S.C. § 1001 et seq., as amended and to enable the carrier to complete the National Association of Insurance Commissioners' (NAIC) annual financial statement.

(4) Health plan purchasing cooperatives shall maintain a cash receipts register of all premiums or contributions received. The minimum detail required in the register shall be date received and deposited, the mode of payment, the policy number, name of policyholder and names of certificate-holders and individual premium amounts and agent.

(5) The description of a disbursement shall be in sufficient detail to identify the source document substantiating the purpose of the disbursement, and shall include all of the following:

(6) If the disbursement is for the earned fee or commission, a written record reflecting the identifying deposit from which the fee was matched shall support the disbursement.

(7) Evidential matter shall support all journal entries for receipts and disbursements. The evidential matters must be referenced in the journal entry so that it may be traced for verification.

(8) The health plan purchasing cooperative shall prepare and maintain monthly financial institution account reconciliations if such service is requested by a participating carrier as provided in the agreement by and between the health plan purchasing cooperative and the carrier.

(9) The health plan purchasing cooperative shall prepare an annual report to be filed with each participating carrier within ninety days of the end of the fiscal year of the plan, which discloses at least all of the following:

(10) A copy of the annual report described in paragraph (9) shall be retained as part of the official record of the health plan purchasing cooperative for at least five (5) years.

(11) Return premiums or contributions shall be paid to the participating carrier, or credited to the account of the participating carrier within thirty (30) days after receipt by the health plan purchasing cooperative. If the return premium or contribution is credited to the carrier, the credit must be shown and applied to the next billing statement sent by the carrier.