044-4 Wyo. Code R. §§ 4-8 - Fiduciary Responsibilities and Payment of Claims

(a) All monies or collateral collected by a TPA on behalf of or for a payor, the return of monies or collateral received from a payor, and any funds held by the TPA for the payment of claims, shall be held by the TPA in a fiduciary capacity. Funds shall be immediately remitted to the person entitled to them or shall be deposited promptly in a fiduciary account established and maintained by the TPA in a federally insured financial institution. The TPA shall render an accounting to the payor, at intervals acceptable to the payor, detailing all transactions performed by the TPA pertaining to the business of the payor, and the written agreement between the payor and the TPA shall include the specifications of this reporting.

(b) The TPA shall keep copies of all records of any fiduciary account maintained or controlled by the TPA, and, upon request of a payor, shall furnish the payor with copies of the records pertaining to the deposits and withdrawals made on behalf of the payor. If funds deposited in a fiduciary account have been collected on behalf of or for more than one payor, or for the payment of claims associated with more than one policy, the TPA shall keep records clearly recording the deposits in and withdrawals from the account on behalf of each payor and relating to each policyholder.

(c) The TPA shall not pay any claim by withdrawals from a fiduciary account in which premiums, plan contributions, or charges are deposited. Withdrawals from a fiduciary account shall be made as provided in the written agreement between the TPA and the payor, and only for the following purposes:

(i) Remittance to a payor entitled to remittance;

(ii) Deposit in an account maintained in the name of the payor;

(iii) Transfer to and deposit in a claims-paying account, with claims to be paid as provided in subsection (d) of this section;

(iv) Payment to a group policyholder for remittance to the payor entitled to such remittance;

(v) Payment to the TPA of its earned commissions, fees or charges;

(vi) Remittance of return premium or plan contributions to the person or persons entitled to such return premium or plan contributions; and

(vii) Payment to other service providers as authorized by the payor.

(d) All claims paid by the TPA from funds collected on behalf of or for a payor shall be paid only as authorized by the payor. Payments from an account maintained or controlled by the TPA for purposes including the payment of claims may be made only for the following purposes:

(i) Payment of valid claims;

(ii) Payment of expenses associated with claims handling to the TPA or to other service providers approved by the payor;

(iii) Remittance to the payor, or transfer to a successor TPA as directed by the payor, for the purpose of paying claims and associated expenses; and

(iv) Return of funds held as collateral or prepayment, to the person entitled to those funds, upon a determination by the payor that those funds are no longer necessary to secure or facilitate the payment of claims and associated expenses.

Notes

044-4 Wyo. Code R. §§ 4-8

Amended, Eff. 11/2/2022.