§ 23-76-109. Powers — Definition
(a) The powers of a health maintenance organization include, but are not limited to, the following: (1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and the property as may reasonably be required for its principal office or for other purposes as may be necessary […]
§ 23-76-125. Rules
(a) After notice and hearing, the Insurance Commissioner may promulgate reasonable rules, not inconsistent with existing statutes of this state, as are necessary or proper to carry out the provisions of this chapter. (b) The rules shall be subject to review in accordance with § 23-61-307.
§ 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.
§ 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, […]