§ 5102. Application; certification, filing, and license fees (a) No person may operate a health maintenance organization without obtaining a certificate of authority from the Commissioner. (b) Application for a certificate of authority shall be made to the Commissioner and include such information and in such form as the Commissioner prescribes, including the following: (1) […]
§ 5102a. Grievance procedures A health maintenance organization shall establish and maintain a grievance or complaint handling procedure which has been approved by the Commissioner to provide for the resolution of grievances and complaints initiated by members. The organization shall respond in writing to any grievance or complaint within 15 days, advising the complainant of […]
§ 5102b. Solvency protections (a) Before issuing any certificate of authority, the Commissioner shall require that the health maintenance organization have an initial net worth of $1,500,000.00 and shall thereafter maintain the minimum net worth required under subsection (b) of this section. (b) Every health maintenance organization must maintain a minimum net worth equal to […]
§ 5103. Precertificate activities The Commissioner, in his or her discretion, may permit an applicant to contact potential members prior to the issuance of a certificate of authority, to discuss the health care services the applicant proposes to offer and the proposed evidences of coverage. (Added 1979, No. 117 (Adj. Sess.).)
§ 5104. Filing and approval of rates and forms; supplemental orders (a)(1) A health maintenance organization which has received a certificate of authority under section 5102 of this title shall file and obtain approval of all policy forms and rates as provided in sections 4062 and 4062a of this title. This requirement shall include the […]
§ 5105. Examinations (a) The Commissioner shall make an examination of the affairs of any health maintenance organization organized or holding a certificate of authority as a health maintenance organization in this State as often as the Commissioner deems it necessary, but not less frequently than once in every three years to ensure that the […]
§ 5106. Annual report to the Commissioner (a) Every organization subject to this chapter, annually, within 90 days of the close of its fiscal year, shall file a report with the Commissioner, said report verified by an appropriate official of the organization, showing its financial condition on the last day of the preceding fiscal year. […]
§ 5107. Powers of health maintenance organizations (a) Health maintenance organizations may: (1) Buy, sell, lease, encumber, construct, renovate, operate, or maintain hospitals, health care clinics, other health care facilities, and other real and personal property which is incidental to and reasonably necessary for the transaction of the business and for the accomplishment of the […]
§ 5107a. Application for continuing authority upon merger, consolidation, transfer of control, or sale of contracts (a) If a health maintenance organization that annually writes more than $10 million of premium in this State intends to merge into or with or consolidate with, transfer more than 10 percent of its stock or other ownership interest, […]
§ 5108. Prohibited practices Section 4724 of this title relating to unfair trade practices shall be construed to apply to health maintenance organizations, except to the extent that the Commissioner determines that the nature of health maintenance organizations renders such section clearly inappropriate. (Added 1979, No. 117 (Adj. Sess.).)
§ 5109. Sanctions Upon satisfactory evidence that any health maintenance organization has violated any law or regulation or in any way has failed in meeting its financial and contractual obligations to its members, including quality assurance as provided by 18 V.S.A. § 9414, the Commissioner may, in the Commissioner’s discretion, pursue any one or more […]
§ 5110. Name of health maintenance organization No health maintenance organization, unless licensed as an insurer, may use in its name, evidences of coverage, contracts, or literature, any of the words “insurance,” “casualty,” “surety,” “mutual,” or any other words descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description […]
§ 5111. Rules The Commissioner may, after notice and hearing, adopt reasonable rules under 3 V.S.A. chapter 25, as are necessary or proper to carry out the provisions of this chapter. (Added 1979, No. 117 (Adj. Sess.); amended 2015, No. 23, § 86.)
§ 5112. Statutory construction and relationship to other laws Except as provided in this chapter, and except as provided in section 3315 and chapter 112, subchapter 2 of this title, provisions of the insurance laws and specifically provisions of chapters 123 and 125 of this title shall not be applicable to any health maintenance organization […]
§ 5113. Severability If any section, term, or provision of this chapter shall be adjudged invalid for any reason, such judgment shall not affect, impair, or invalidate any other section, term, or provision of this chapter, but the remaining section, terms, and provisions shall be and remain in full force and effect. (Added 1979, No. […]
§ 5114. Part-time employees A health maintenance organization shall not exclude part-time employees or refuse to offer the same benefits to part-time employees as it offers to the employee groups of which the part-time employees would be members if they were full-time employees. The insurer shall offer to include the part-time employees as part of […]
§ 5115. Duty of nonprofit health maintenance organizations Any nonprofit health maintenance organization subject to this chapter shall offer nongroup plans to individuals in accordance with 33 V.S.A. § 1811 without discrimination based on age, gender, industry, and medical history, except as allowed by subdivisions 4080g(b)(7)(B)(ii) and 4080g(c)(8)(B)(ii) of this title and by 33 V.S.A. […]
