§ 23-76-129. Medical information confidential — Exceptions
(a) Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from the person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out […]
§ 23-76-130. Insurance Commissioner’s authority to contract
(a) The Insurance Commissioner may contract with qualified persons to make recommendations concerning the adequacy, network adequacy, or accessibility of healthcare services under a healthcare plan furnished or proposed to be furnished by a health maintenance organization. (b) The commissioner may accept all or part of the recommendations.
§ 23-76-131. Tax on premiums and copayments
(a) (1) (A) (i) Each health maintenance organization shall pay a tax on the premiums for coverages provided during the calendar year. (ii) The tax shall be paid on an annual basis and on a quarterly estimate basis as prescribed by the Insurance Commissioner and reconciled at the time of filing the annual statement. (B) […]
§ 23-76-132. College students
If a health maintenance organization requires the selection or assignment of a primary care physician, the health maintenance organization shall provide an enrollee who is a student enrolled at a postsecondary institution one (1) of the following options: (1) To select two (2) primary care physicians, one (1) located near the enrollee’s domicile and one […]
§ 23-76-110. Advisory board
(a) The advisory board of any health maintenance organization shall include at least one (1) physician, one (1) dentist, one (1) pharmacist, one (1) nurse, one (1) consumer, and one (1) enrollee. (b) The advisory board shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through […]
§ 23-76-126. Administrative proceedings
(a) (1) If the Insurance Commissioner has cause to believe that grounds for the suspension or revocation of a certificate of authority exist, the commissioner shall: (A) Notify the health maintenance organization in writing of the grounds for suspension or revocation of the certificate of authority; and (B) Schedule a hearing on the matter at […]
§ 23-76-111. Fiduciary responsibilities of director, officer, or partner
(a) Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the health maintenance organization shall be responsible for the funds in a fiduciary relationship to the enrollees. (b) A health maintenance organization shall maintain in force a fidelity bond or fidelity […]
§ 23-76-127. Fees
A health maintenance organization subject to this chapter shall pay to the State Insurance Department Trust Fund as special revenues the following fees: (1) For filing and reviewing all documents necessary for issuance of an original certificate of authority, one thousand dollars ($1,000); (2) For issuance of the original certificate of authority, two hundred dollars […]
§ 23-76-112. Evidence of coverage and charges for healthcare services
(a) (1) (A) Every enrollee residing in this state is entitled to evidence of coverage under a healthcare plan. (B) If the enrollee obtains coverage under a healthcare plan through an insurance policy or a contract issued by a hospital and medical service corporation, whether by option or otherwise, the insurer or the hospital and […]
§ 23-76-128. Applications, filings, and reports public
All applications, filings, and reports required under this chapter shall be treated as public documents.