§ 83-41-305. Requirement of certificate of authority for establishment and operation of health maintenance organization; filing, form and contents of application for certificate and attachments; qualification of foreign health maintenance organizations; effect of denial of certificate; rules and regulations
Notwithstanding any law of this state to the contrary, any person may apply to the commissioner for a certificate of authority to establish and operate a health maintenance organization in compliance with this article. No person shall establish or operate a health maintenance organization in this state, without obtaining a certificate of authority under this […]
§ 83-41-307. Transmission of copies of application for certificate of authority to State Health Officer; duties of State Health Officer; grant or denial of certificate of authority
Upon receipt of an application for issuance of a certificate of authority, the commissioner shall forthwith transmit copies of the application and accompanying documents to the State Health Officer. The State Health Officer shall determine whether the applicant for a certificate of authority, with respect to health care services to be furnished has complied with […]
§ 83-41-309. Powers of health maintenance organization generally; notice of exercise of powers affecting financial condition of organization
The powers of a health maintenance organization include, but are not limited to, the following: The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and any property as may reasonably be required for its principal office or for those purposes as may be necessary in the […]
§ 83-41-311. Bonds or insurance for directors, officers, employees, partners and contractors
Any director, officer, employee, contractor or partner of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of such organization shall be responsible for the funds in a fiduciary relationship to the organization. A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on […]
§ 83-41-313. Quality assurance procedures, programs and activities; maintenance and examination of patient records
The health maintenance organization shall establish procedures to assure that the health care services provided to enrollees shall be rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice. The procedures shall include mechanisms to assure availability, accessibility and continuity of care. The health maintenance organization shall have […]
§ 83-41-315. Filing, contents and approval of group and individual contracts and evidence of coverage
Every group and individual contract holder is entitled to a group or individual written contract respectively. The contract shall not contain provisions or statements which are unjust, unfair, inequitable, misleading, deceptive, or which encourage misrepresentation as defined by the Unfair Trade Practices Act. The contract shall contain a clear statement of the following: Name and […]
§ 83-41-317. Filing of annual reports, financial statements, etc.
Every health maintenance organization shall annually, on or before the first day of March, file a report verified by at least two (2) principal officers with the commissioner, with a copy to the State Health Officer, covering the preceding calendar year. Such report shall be on and in accordance to the National Association of Insurance […]
§ 83-41-319. Provision of information and notices to subscribers
The health maintenance organization shall provide to its subscribers a list of providers, upon enrollment, re-enrollment or at a minimum annually. Every health maintenance organization shall provide within thirty (30) days to its subscribers notice of any material change in the operation of the organization that will affect them directly. An enrollee must be notified […]
§ 83-41-321. Grievance procedures
Every health maintenance organization shall establish and maintain a grievance procedure which has been approved by the commissioner, after consultation with the State Health Officer, to provide procedures for the resolution of grievances initiated by enrollees. The health maintenance organization shall maintain records regarding grievances received since the date of its last examination of such […]
§ 83-41-323. Funds
With the exception of investments made in accordance with Section 83-41-309(1)(a), the funds of a health maintenance organization shall be invested only in accordance with investment permitted by the laws of the State of Mississippi for life insurance companies (Section 83-19-51 et seq., Mississippi Code of 1972).