The Business of InsuranceAdministrators
Section § 1759
This section defines who qualifies as an 'administrator' related to life or health insurance coverage in California. An 'administrator' is someone who collects charges or settles claims for insurance, except for specific exceptions. The list of exceptions includes employers, unions, licensed insurance companies and agents, creditors, certain trusts, banks, credit card companies, attorneys, licensed adjusters, nonprofit agricultural associations, and certain regulated entities under the Health and Safety Code. These exceptions are not considered administrators for the purpose of this law.
Section § 1759.1
This law states that administrators must have a written agreement with insurers before they can act in their role. This agreement should be kept as an official record by both the insurer and the administrator for the length of the agreement, plus five more years. The agreement must include specific requirements outlined in related sections, unless they're not relevant to the administrator's tasks.
If a policy is issued to a trustee, the administrator must provide the insurer with a copy of the trust agreement, including any changes. This documentation should also be kept on file by both parties for the policy's duration and for an additional five years.
Section § 1759.2
This law explains how payments work when an insurance company hires an administrator to manage its policies. If you pay your insurance premium through an administrator, it counts as paid directly to the insurance company. However, when the insurance company sends money back for things like refunds or claims, it's not considered paid to you until you actually receive it. Also, if the administrator doesn't pass on payments properly, the insurance company can still take action against them.
Section § 1759.3
This law requires insurance administrators to maintain thorough and accurate records of all transactions with insurers and insured parties. These records must be kept for the duration of any agreements and for five years after, and must meet standard insurance recordkeeping practices.
Insurers have the right to access these records to fulfill their obligations, while the commissioner can access them for audits or inspections. The information in the records is confidential but can be used in proceedings against an administrator if necessary.
The commissioner can also set rules about how these records should be kept. If an administrator fails to maintain the required records, they risk losing their registration certificate after due process.
Section § 1759.4
In California, if you manage or run insurance programs, you can only use advertisements that the insurance company has looked at and approved before you use them. This means any ad you want to release must first be checked and accepted by the insurer who underwrites the business.
Section § 1759.5
This law section says that an agreement must include details about the guidelines or standards used by an insurance company for accepting or refusing insurance business.
Section § 1759.6
When insurance premiums and charges are collected by an administrator (a person or company handling insurance tasks), they must be kept safe in a fiduciary (trust-based) manner. These funds should be sent immediately to the rightful owner or deposited in a special bank account set up by the administrator. If the funds are for multiple insurers, the administrator must keep detailed records for each insurer's money.
The administrator needs to maintain copies of these records and provide them to insurers if requested. The money in this fiduciary account cannot be used to pay claims. Instead, withdrawals must follow a written agreement with the insurer and can include remitting money to the insurer, depositing it for the insurer, transferring it to a claims-paying account, or paying the administrator's own fees. Return premiums (refunds) should also be given back to the rightful parties.
Section § 1759.7
Under this law, any claims that are paid out by an administrator from the money collected for an insurer must be done so through checks or drafts that are approved by the insurer. Alternatively, with the insured person's permission, the payment can be made via electronic funds transfer authorized by the insurer.
Section § 1759.8
This law states that when an administrator is responsible for adjusting or settling claims on insurance policies, their pay cannot be influenced by how the claims turn out. In simpler terms, they shouldn't be paid more or less depending on the claim results.
Section § 1759.9
If an administrator is handling your insurance, they must give you a notice, approved by the insurance company, explaining who they are and how they are connected to the insurance company and policyholder. When the administrator collects money, they must clearly separate and specify in writing any insurance charges or premiums.
Section § 1759.10
If you want to work as an insurance administrator in this state and you're not already a licensed adjuster, you need a registration certificate from the commissioner. This certificate must meet specific rules and fees similar to those for life insurance agents, but with some exceptions. Additionally, all administrators need to follow certain requirements in Section 1724.5.