Skip to main content

Article 9

IA-BOD-RES 9/2011 Effective from 4/12/2011

Pursuant to the provisions of Clause (5) of Article (8) herein:

  1. The agreement to be executed between the Health Insurance Third Party Administrator and the Insurance Company must set forth the rights and obligations of the parties thereto including:
     
    1. A description of the nature of services mutually agreed upon to be provided by the Health Insurance Third Party Administrator.

    2. A statement of the rights and obligations of each party in the contracts concluded on behalf of the Insurance Company with the Medical Service Providers.

    3. The term of the agreement and cases requiring the termination thereof.

    4. Method of calculating the fees of the Health Insurance Third Party Administrator.

    5. The right of the Insurance Company to have access to the books and records related to the business between the two parties and how to obtain copies thereof.

    6. Period of settlement and payment of claims.

    7. An authorization from the Insurance Company to the Health Insurance Third Party Administrator to enter into agreements with the Medical Service Providers on behalf of the Insurance Company.

    8. The controls and procedures governing the management of contractual funds.

    9. Determining the information related to statistical reports to be periodically prepared by the Health Insurance Third Party Administrator for the Insurance Company.

    10. Determining files, books and records that should be kept by the Health Insurance Third Party Administrator on regularly basis.
       
  2. The agreement concluded between the Health Insurance Third Party Administrator and the Medical Service Providers must set forth the rights and obligations of each party, the work mechanism between them, and charges and rates to be used in the payment of claims, as well as periods of claim settlement and payment. The agreement must enclose a document from the Insurance Company stating that the Health Insurance Third Party Administrator has concluded the agreement with the Medical Service Providers on behalf of the Insurance Company.
     
  3. An agreement containing the provisions set out in Clauses (1) and (2) of this Article shall be concluded by and between the Health Insurance Third Party Administrator, the Insurance Company and the Medical Service Providers.