The schedule of premiums to be charged eligible individuals for a benefit plan must be established by the lead carrier and approved by the board, but may not exceed 155% of the individual premium rates charged for similar coverage throughout the state. If similar coverage is not offered by other insurance carriers, premium rates for actuarial equivalent benefit plans offered by other insurers in the state must be provided by the commissioner and utilized by the lead carrier to determine association rates for the benefit plans.

The lead carrier must be reimbursed from the association plan premiums received for its direct and indirect expenses. The lead carrier shall: Perform all administrative and claims payment functions required under this chapter; Determine eligibility of individuals requesting coverage through the association; Provide all eligible individuals involved in the association an individual certificate setting forth a statement as to the insurance protection to which the individual is entitled, the method and place of filing claims, and to whom benefits are payable; Pay all claims under this chapter and indicate that the association paid the [...]