# Title 45 — Insurance, Commissioner of

## Article 45-06 — Accident and Health Insurance

## Chapter 45-06-09 — Group Health Insurance Purchasing Cooperatives

### § 45-06-09-01. Purpose and intent.

The purpose of this chapter is to further improve the fairness, efficiency, and competition in the
pricing and delivering of health care and health care coverage. It does so by allowing for the
establishment of joint purchasing entities (purchasing cooperatives) through which eligible small
employers can purchase health coverage for their employees.
History: Effective August 1, 1994.
General Authority: NDCC 26.1-01-07.4
Law Implemented: NDCC 26.1-01-07.4
### § 45-06-09-02. Applicability and scope.

This chapter applies to all health insurance purchasing cooperatives operating in this state or
providing coverage to North Dakota residents. Health purchasing cooperatives are subject to the small
employer employee health insurance coverage requirements contained in North Dakota Century Code
chapter 26.1-36.3. This chapter does not apply to any other health insurance or health care buying or
marketing mechanism otherwise permitted by law.
History: Effective August 1, 1994.
General Authority: NDCC 26.1-01-07.4
Law Implemented: NDCC 26.1-01-07.4
### § 45-06-09-03. Definitions.

1. "Business plan" means the plan of operation of the health insurance purchasing cooperative.
2. "Commissioner" means the insurance commissioner.
3. "Group" means a collection of small employers subject to the requirements of North Dakota
Century Code chapter 26.1-36.3 who elect to join together to form a group health insurance
purchasing cooperative. It does not include an industrywide trade association meeting the
exemption requirements outlined in subsection 15 of North Dakota Century Code section
August 1, 1994.
4. "Health insurance purchasing cooperative" means a group of small employers who join
together to purchase health insurance.
History: Effective August 1, 1994; amended effective April 1, 2010.
General Authority: NDCC 26.1-01-07.4
Law Implemented: NDCC 26.1-01-07.4

### § 45-06-09-04. Commissioner duties - Filing requirements - Audits and examinations.

1. The commissioner has the authority to regulate the establishment and conduct of health
insurance purchasing cooperatives as set forth in this chapter.
2. The commissioner has the authority to conduct financial and performance audits on health
insurance purchasing cooperatives operating in the state. The costs of such audits shall be
the responsibility of the purchasing cooperative.
3. Each health insurance purchasing cooperative doing business in the state shall file with the
commissioner the following information or documents:
a. A business plan for approval by the commissioner.
b. Annual reports identifying the number of individuals insured through the cooperative, the
names of insurance companies providing coverage to cooperative members and rates
charged for insurance policies provided through the cooperative, and any proposed
changes in the business plan of the cooperative.
4. a. A health insurance purchasing cooperative may not enter the marketplace until the
commissioner has approved the business plan.
b. Any material changes to the business plan must be submitted to the commissioner for
approval prior to implementation.
History: Effective August 1, 1994.
General Authority: NDCC 26.1-01-07.4
Law Implemented: NDCC 26.1-01-07.4
### § 45-06-09-05. Business plan.

A health insurance purchasing cooperative shall submit a business plan for review and approval by
the commissioner. The business plan must include the following information:
1. The specific steps by the health insurance purchasing cooperative to advance cost control,
quality improvement, and improved access to health insurance and health care services.
2. The scope of health insurance purchasing cooperative services to be offered in the service
territory and the resources and expertise to be used to implement and administer the plan.
3. The corporate chart, bylaws, and other business operation documents of the health insurance
purchasing cooperative.
4. A list of officers and directors of the health insurance purchasing cooperative and the contract
administrator if one is employed.
5. Evidence of adequate security and prudence in the accounting, deposit, collection, handling,
and transfer of moneys.
6. Any other information required by the commissioner to verify the purchasing group is qualified
to administer the benefit plan.
History: Effective August 1, 1994.
General Authority: NDCC 26.1-01-07.4
Law Implemented: NDCC 26.1-01-07.4

### § 45-06-09-06. Conflict of interest.

1. Health care providers or insurers offering competing products within the same service territory
may not participate in a health insurance purchasing cooperative as a sponsor or
administrator.
2. A health insurance purchasing cooperative sponsor or administrator may not be an employee
or a subsidiary of a health care provider or insurer offering competing products within the
same service territory.
3. The employees of a health care provider or insurer may receive services through a health
insurance purchasing cooperative. The employer may vote in corporate governance elections
for officers and directors. A health care provider, insurer, or an employee of a health care
provider or insurer may not serve as an officer or director of a health insurance purchasing
cooperative.
History: Effective August 1, 1994.
General Authority: NDCC 26.1-01-07.4
Law Implemented: NDCC 26.1-01-07.4
### § 45-06-09-07. Insurance risk.

Repealed effective April 1, 2010.
### § 45-06-09-08. Bonding protection.

Health insurance cooperatives collecting premiums shall provide bonding coverage for cooperative
employees handling funds. Evidence of bond coverage sufficient to cover the volume of premium
collected by the purchasing cooperative must be filed with the annual report required under
subdivision b of subsection 3 of section 45-06-09-04.
History: Effective August 1, 1994.
General Authority: NDCC 26.1-01-07.4
Law Implemented: NDCC 26.1-01-07.4
