§ 83-41-301. Short title

This article may be cited as the Health Maintenance Organization, Preferred Provider Organization and Other Prepaid Health Benefit Plans Protection Act.

§ 83-41-303. Definitions

“Basic health care services” means the following medically necessary services: preventive care, emergency care, inpatient and outpatient hospital and physician care, diagnostic laboratory and diagnostic and therapeutic radiological services and includes but is not limited to mental health services or services for alcohol or drug abuse, dental or vision services or long-term rehabilitation treatment for […]

§ 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).

§ 83-41-325. Minimum net worth requirement; deposits generally; computation of liabilities; contracts between health maintenance organizations and participating providers of services; insolvency plans

Before issuing any certificate of authority, the commissioner shall require that the health maintenance organization have an initial net worth of One Million Five Hundred Thousand Dollars ($1,500,000.00) and shall thereafter maintain the minimum net worth required under subsection (2). Except as provided in subsections (3) and (4) of this section, every health maintenance organization […]

§ 83-41-327. Uncovered expenditures insolvency deposits

If at any time uncovered expenditures exceed ten percent (10%) of total health care expenditures, a health maintenance organization shall place an uncovered expenditures insolvency deposit with the commissioner, with any organization or trustee acceptable to the commissioner through which a custodial or controlled account is maintained, cash or securities that are acceptable to the […]

§ 83-41-329. Proceedings upon insolvency of health maintenance organization; terms and conditions of replacement coverage

In the event of an insolvency of a health maintenance organization, upon order of the commissioner all other carriers that participated in the enrollment process with the insolvent health maintenance organization at a group’s last regular enrollment period shall offer such group’s enrollees of the insolvent health maintenance organization a thirty-day enrollment period commencing upon […]

§ 83-41-331. Premium rates

No premium rate may be used until either a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the commissioner. Either a specific schedule of premium rates, or a methodology for determining premium rates, shall be established in accordance with actuarial principles for various categories of enrollees, […]

§ 83-41-333. Rules and regulations generally; exemptions from certification requirement

The commissioner may, after notice and hearing, promulgate rules and regulations as are necessary to provide for the licensing of health maintenance organization producers. The rules shall establish: The requirements for licensure of resident health maintenance organization producers; The conditions for entering into reciprocal agreements with other jurisdictions for the licensure of nonresident health maintenance […]

§ 83-41-335. Operation of health maintenance organizations by insurance companies and medical service corporations

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 article. Any two (2) or more insurance companies, hospital or medical service corporations, […]

§ 83-41-337. Examination of health maintenance organizations and providers; acceptance of reports in lieu of examinations

The commissioner shall make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state but not less frequently than once every five (5) years at […]

§ 83-41-339. Grounds and procedure for revocation, suspension or denial of certificate of authority; administrative penalty generally; correction of deficiencies in net worth; proceedings upon suspension or revocation of certificate of authority; appeals

Any certificate of authority issued under this article may be suspended or revoked, and any application for a certificate of authority may be denied, if the commissioner after a hearing finds that any of the conditions listed below exist: The health maintenance organization is operating significantly in contravention of its basic organizational document or in […]