NAC287.387. Administrative fee: Establishment by Program; calculation; notice.

     1. To recoup the administrative costs incurred by the Program related to opt-out plans, the Program shall, for each fiscal year, establish a monthly per capita administrative fee to be charged to each opt-out plan for each participant in the opt-out plan.

     2. The administrative fee charged to each opt-out plan each month pursuant to subsection 1 must be based on the number of participants in the opt-out plan during that month.

     3. The per capita administrative fee must be calculated by:

     (a) Subtracting from the amount of the annual budget of the Program:

          (1) Consulting fees incurred by the Program for health benefits for participants in the Program;

          (2) Fully insured costs of the Program;

          (3) Administrative costs for the plan of self-insurance of the Program;

          (4) Expenses for claims made by participants in the plan of self-insurance of the Program;

          (5) Reserve expenses for the plan of self-insurance of the Program; and

          (6) Any other costs incurred by the Program that the Program deems to be unrelated to participants in opt-out plans.

     (b) Dividing the number determined pursuant to paragraph (a) by the total number of persons who are participating in the Program or in an opt-out plan during the 10th month of the fiscal year immediately preceding the fiscal year for which the fee is being established.

     (c) Dividing the number determined pursuant to paragraph (b) by 12.

     4. The administrative fee must be calculated and provided in writing to each opt-out plan not later than 60 days before the beginning of each fiscal year.

     (Added to NAC by Bd. of Pub. Employees’ Benefits Prog. by R097-03, eff. 9-24-2003)