(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 […]
(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 […]
(a) The Insurance Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if the commissioner finds that any of the following conditions exist: (1) The health maintenance organization is operating in contravention of its basic organizational document, its healthcare plan, or in a manner contrary to […]
(a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the Insurance Commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies. (b) The commissioner may apply for […]
(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.
(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 […]
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 […]
All applications, filings, and reports required under this chapter shall be treated as public documents.
(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 […]
(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.
(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) […]
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 […]
