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Chapter 8. Office of the Director
Subchapter 2. Administration of Self-Insurance Plans
Article 13. Group Self Insurance

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§15475.1. Separation Among Service Providers.

(a) No claims administrator or employee, officer, or director of a claims administrator shall be an employee, officer or director of, or have a direct or indirect management or financial interest in either the Group Administrator or an affiliate member of the private group self insurer, nor shall any owner or employee of the Group Administrator or affiliate member of the private group self insurer be an owner, employee, officer or director of, or have a direct or indirect management or financial interest in the claims administrator.

(b) No Group Administrator, claims administrator, or insurance broker or employee, officer, or director thereof, shall serve as the certified public accountant for any group self insurer for which it provides services as a Group Administrator, claims administrator or insurance broker, respectively, nor shall any owner or employee of an affiliate group member of group self insurer serve as the certified public accountant for the group self insurer.

(c) No insurance broker of a group self insurer, or employee, officer, or director of such insurance broker with a direct or indirect management or financial interest in the group self insurer's claims administrator shall be an employee, officer or director of, or have a direct or indirect management or financial interest in the Group Administrator of the same group self insurer unless the Group Administrator notifies the group self insurer in writing of its relationship, and in no event shall the group self insurer be required by the Group Administrator to utilize the Group Administrator as broker.

(d) No actuary of a private self insured group preparing a written actuarial report pursuant to Section 15475(d)(7) shall be an employee, officer or director of, or have a direct or indirect management or financial interest in the Group Administrator of the same private self insured group unless the Group Administrator notifies the group self insurer and the Manager in writing of its relationship; notwithstanding this subsection, the Manager at his or her discretion may require that a written actuarial report pursuant to Section 15475(d)(7) be prepared at the expense of the group self insurer by an independent actuary with no relationship to the group administrator.

(e) No claims bill reviewer of a group self insurer shall be an employee, officer, or director of, or have a direct or indirect management or financial interest in, the Group Administrator of the group self insurer unless the Group Administrator notifies the group self insurer and the Manager in writing of its relationship. In no event shall the group self insurer be required by the Group Administrator to utilize services of the claims bill reviewer in which the Group Administrator has a direct or indirect interest.
     Note: Authority cited: Sections 54, 55 and 3702.10, Labor Code. Reference: Sections 3700, 3700.1, 3701, 3701.5, 3702.1, 3702.2 and 3702.10, Labor Code.  

 HISTORY 
   
1. New section filed 3-2-2009; operative 3-2-2009 pursuant to  Government Code section 11343.4 (Register 2009, No. 10).

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