§ 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 […]
§ 23-76-129. 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 […]
§ 23-76-114. Information to enrollees
(a) A health maintenance organization shall make available to its subscribers a list of providers upon enrollment and re-enrollment. (b) Every health maintenance organization shall provide within thirty (30) days to its subscribers a notice of any material change in the operation of the health maintenance organization, including any major change in its provider network, […]
§ 23-76-115. Open enrollment
(a) (1) After a health maintenance organization has been in operation twenty-four (24) months, it shall have an annual open enrollment period of at least one (1) month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for […]
§ 23-76-116. Complaint system
(a) (1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning healthcare services. (2) Each health maintenance organization shall submit to the commissioner an annual report in a form prescribed by […]
§ 23-76-117. Investments
With the exception of investments made in accordance with § 23-76-109(a)(1) and (2) and § 23-76-109(b), the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies or other […]
§ 23-76-118. Protection against insolvency
(a) Deposit Requirements. (1) (A) All health maintenance organizations authorized to transact business in this state shall deposit through the Insurance Commissioner securities eligible for deposit under § 23-63-903 that at all times shall have a par or market value of not less than three hundred thousand dollars ($300,000), with the exception of limited benefit […]
§ 23-76-119. Prohibited practices — Definition
(a) No health maintenance organization, or representative thereof, may knowingly cause or knowingly permit the use of advertising that is untrue or misleading, solicitation that is untrue or misleading, or any form of evidence of coverage that is deceptive. For purposes of this chapter: (1) A statement or item of information shall be deemed to […]