N.M. Stat. § 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.