§ 23-76-113. Annual report and quarterly report
(a) A health maintenance organization shall annually on or before March 1 file a report verified by at least two (2) principal officers with the Insurance Commissioner covering the preceding calendar year. (b) (1) The report shall be on forms prescribed by the commissioner. (2) For the report to be filed March 1, 2002, and […]
§ 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 […]
§ 23-76-120. Regulation of agents — Definition
(a) After notice and hearing, the Insurance Commissioner may promulgate such reasonable rules as are necessary to provide for the licensing of agents. (b) “Agent” means a person directly or indirectly associated with a healthcare plan who engages in solicitation or enrollment.
§ 23-76-121. Powers of insurers and hospital and medical service corporations
(a) An insurance company licensed in this state, or a hospital or medical service corporation authorized to do business in this state, may either directly, or through a subsidiary or affiliate, organize and operate a health maintenance organization under the provisions of this chapter. (b) (1) Notwithstanding any provision of the Hospital and Medical Service […]
§ 23-76-122. Examinations
(a) The Insurance Commissioner may make an examination of the affairs of any health maintenance organization as often as he or she deems it necessary for the protection of the interests of the people of this state but not less frequently than one (1) time every three (3) years. (b) The commissioner may make an […]