South Carolina Code 38-71-1355. Health group cooperative; powers and duties
(2) shall collect premiums to cover the cost of:
Terms Used In South Carolina Code 38-71-1355
- Contract: A legal written agreement that becomes binding when signed.
- cooperative: means a private purchasing cooperative composed of small employers formed under this article. See South Carolina Code 38-71-1330
- insurance: includes annuities. See South Carolina Code 38-1-20
- Insurer: means an entity that provides health insurance in this State. See South Carolina Code 38-71-1330
- Negotiate: means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning substantive benefits, terms, or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance from insurers for purchasers. See South Carolina Code 38-1-20
- Person: means a corporation, agency, partnership, association, voluntary organization, individual, or another entity, organization, or aggregation of individuals. See South Carolina Code 38-1-20
- plan: means any hospital or medical policy or certificate, major medical expense insurance, hospital or medical service plan contract, or health maintenance organization subscriber contract that provides benefits consisting of medical care provided directly through insurance or reimbursement, or otherwise and including items and services paid for medical care. See South Carolina Code 38-71-1330
- Small employer: means , in connection with a health insurance plan with respect to a calendar year and a plan year, any person, firm, corporation, partnership, association, or employer, as defined in Section 3(5) of the Employee Retirement Income Security Act of 1974, that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar year, employed no more than fifty eligible employees or employed an average of not more than fifty employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. See South Carolina Code 38-71-1330
(a) group health insurance plan coverage purchased through the cooperative; and
(b) the cooperative’s administrative expenses;
(3) may contract with agents to market coverage issued through the cooperative;
(4) shall establish administrative and accounting procedures for the operation of the cooperative;
(5) shall establish procedures under which an applicant for or participant in coverage issued through the cooperative may have a grievance reviewed by an impartial person;
(6) may contract with a small employer insurer or third-party administrator to provide administrative services to the cooperative;
(7) shall contract with small employer insurers for the provision of services to small employers covered through the cooperative;
(8) shall develop and implement a plan to maintain public awareness of the cooperative and publicize the eligibility requirements and the procedures for enrollment in coverage through the cooperative;
(9) may negotiate the premiums paid by its members; and
(10) may offer other ancillary products and services to its members as are customarily offered in conjunction with group health insurance plans.