Ga. Comp. R. & Regs. R. 120-2-49-.05 - Maintenance of Information; Books and Records; Reporting Requirements; Return Credits; Correction o
(1) Every administrator shall maintain at its
principal administrative office for the duration of the written agreement
referred to in Rule
120-2-49-.04 and five years
thereafter books and records of all transactions between it, insurers,
self-insurers 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 administrator. The insurer shall retain the right to continuing
access to such books and records of the administrator sufficient to permit the
insurer to fulfill all of its contractual obligations to insured persons,
subject to any restrictions in the written agreement between the insurer and
administrator on the proprietary rights of the parties in such books and
records.
(2) Administrators shall
maintain detailed books and records that reflect all administered transactions
specifically in regard to premiums, premium taxes, agent's commissions,
administrator's fees, contributions received and deposited and claims and
authorized expenses paid.
(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
between the administrator and the insurer, self-insurer, or plan sponsor, and
in accordance with the "Employee Retirement and Income Security Act of 1974,"
88 Stat. 829, 29 U.S.C.
ยง
1001
et seq., as
amended and to enable the insurer to complete the National Association of
Insurance Commissioners' annual financial statement.
(4) All books and records maintained by an
administrator on behalf of an insurer, self-insurer or plan sponsor for a
calendar or fiscal year shall be maintained for the period in which the
administrator is providing service for the insurer, self-insurer or plan
sponsor and for five years thereafter.
(5) Administrators shall maintain a cash
receipts register of all premiums or contributions received. The minimum detail
required in the register shall be:
(a) Date
received and deposited;
(b) The
mode of payment;
(c) The policy
number;
(d) Name of group
policyholder;
(e) Names of
certificate-holders;
(f) Individual
premium amounts; and
(g)
Agent.
(6) 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:
(a) The check
number;
(b) The date of
disbursement;
(c) The person to
whom the disbursement was made;
(d)
The amount disbursed. If the amount disbursed does not agree with the amount
billed or authorized, the administrator shall prepare a written record as to
the application for the disbursement; and
(e) Ledger account number.
(7) If the disbursement is for the
earned administrative fee or commission, the disbursement shall be supported by
a written record reflecting the identifying deposit from which the fee was
matched.
(8) All journal entries
for receipts and disbursements shall be supported by evidential matter. The
evidential matters must be referenced in the journal entry so that it may be
traced for verification.
(9) The
administrator shall prepare and maintain monthly financial institution account
reconciliations if such service is requested by an insurer or plan sponsor as
provided in the service agreement by and between the administrator and the
insurer or plan sponsor.
(10) The
administrator shall prepare a report to be filed with the insurer and plan
sponsor within ninety days of the end of the fiscal year of the plan, which
discloses at least all of the following:
(a)
The total premiums or contributions received from the plan sponsor, covered
persons, or beneficiaries;
(b) The
total administration fees withdrawn by the administrator pursuant to the
written service agreement;
(c) The
total claim payments made during the reporting period;
(d) A copy of the annual report shall be
retained as part of the official record of the third party administrator for at
least five (5) years;
(e) Any
additional information required by the written agreement; and
(f) The names of all insurers, reinsurance
carriers or ultimate risk bearers providing any type of insurance coverage to
the plan sponsor.
(11)
Return premiums or contributions shall be paid to the insurer, or self-insurer
or plan sponsor or credited to the account of the insurer, self-insurer or plan
sponsor within thirty days after receipt by the administrator. If the return
premium or contribution is credited to the insurer, self-insurer or plan
sponsor, the credit must be shown and applied to the next billing statement
sent to the insurer, self-insurer or plan sponsor.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.