§33-25D-1. Short Title

This article may be cited as the "Prepaid Limited Health Service Organization Act."

§33-25D-10. Provider Contracts

(a) A prepaid limited health service organization shall file with the commissioner any contracts made with providers of a limited health service, enabling the prepaid limited health service organization to provide limited health services authorized under this article. The commissioner may require the immediate cancellation of a contract or the immediate renegotiation of a contract […]

§33-25D-11. Evidence of Coverage; Review of Enrollee Records; Charges for Limited Health Services; Cancellation of Contract by Enrollee

(a)(1) Every enrollee is entitled to evidence of coverage in accordance with this section. The prepaid limited health service organization or its designated representative shall issue the evidence of coverage. (2) No evidence of coverage, or amendment thereto, shall be issued or delivered to any person in this state until a copy of the form […]

§33-25D-12. Annual and Quarterly Reports

(a) Every prepaid limited health service organization shall comply with and is subject to the provisions of section fourteen, article four of this chapter relating to filing of financial statements with the commissioner and the national association of Insurance Commissioners. The annual financial statement required by that section shall include, but not be limited to, […]

§33-25D-13. Annual Report to Enrollees

Every prepaid limited health service organization or its representative shall annually, before April 1, provide to each enrollee a summary of: Its most recent annual financial statement, including a balance sheet and statement of receipts and disbursements; a description of the prepaid limited health service organization, each limited health service offered, its facilities and personnel […]

§33-25D-14. Grievance Procedure

(a) A prepaid limited health service organization shall establish and maintain a grievance procedure, which has been approved by the commissioner, to provide adequate and reasonable procedures for the expeditious resolution of written grievances initiated by enrollees concerning any matter relating to any provisions of the organization's limited health service contracts, including, but not limited […]

§33-25D-15. Prohibited Practices

(a) No prepaid limited health service organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. No advertising may be used until it has been approved by the commissioner. Advertising which […]

§33-25D-16. Agent Licensing and Appointment Required; Regulation of Marketing

(a) Prepaid limited health service organizations are subject to the provisions of article twelve of this chapter. (b) With respect to individual or group contracts covering fewer than twenty-five subscribers, after a subscriber signs a prepaid limited health service organization enrollment application and before the prepaid limited health service organization may process the application changing […]

§33-25D-17. Powers of Insurers, Hospital Service Corporations, Medical Service Corporations, Dental Service Corporations, Health Service Corporations and Health Maintenance Organizations

(a) An insurance company licensed in this state, a hospital, medical, dental or health service corporation authorized to do business in this state or a health maintenance organization holding a certificate of authority under article twenty-five-a of this chapter, after applying for and receiving a certificate of authority as a prepaid limited health service organization, […]

§33-25D-18. Examinations

(a) The commissioner may make an examination of the affairs of any prepaid limited health service organization and providers with whom the organization has contracts, agreements or other arrangements as often as he or she considers it necessary for the protection of the interests of the people of this state but not less frequently than […]

§33-25D-19. Quality Assurance

(a) Each prepaid limited health service organization shall have in writing a quality assurance program approved by the commissioner which describes the program's objectives, organization and problem solving activities. (b) The scope of the quality assurance program shall include, at a minimum: (1) Organizational arrangements and responsibilities for quality management and improvement processes;

§33-25D-2. Definitions

(a) "Capitation" means the fixed amount paid by a prepaid limited health service organization to a health care provider under contract with the prepaid limited health service organization in exchange for the rendering of no more than four limited health services. (b) "Commissioner" means the Commissioner of Insurance. (c) "Consumer" means any person who is […]

§33-25D-20. Suspension or Revocation of Certificate of Authority

(a) The commissioner may suspend or revoke any certificate of authority issued to a prepaid limited health service organization under this article if he or she finds that any of the following conditions exist: (1) The prepaid limited health service organization is operating significantly in contravention of its basic organizational document, in any material breach […]

§33-25D-21. Rehabilitation, Liquidation or Conservation of Prepaid Limited Health Service Organization

Any rehabilitation, liquidation or conservation of a prepaid limited health service organization is considered to be the rehabilitation, liquidation or conservation of an insurance company, is the exclusive remedy for rehabilitation, liquidation and conservation of a prepaid limited health service organization as provided by this article and shall be conducted under the supervision of the […]

§33-25D-22. Rules

The commissioner may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code: (1) To effectuate the purposes of this article and to prevent circumvention and evasion thereof; and

§33-25D-23. Administrative Procedures

(a) When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, he or she shall notify the prepaid limited health service organization in writing specifically stating the grounds for denial, […]

§33-25D-24. Fees

Every prepaid limited health service organization subject to this article shall pay to the commissioner the following fees: (1) For filing an application for a certificate of authority or amendment thereto, $200;

§33-25D-25. Penalties and Enforcement

(a) The commissioner may, in lieu of suspension or revocation of a certificate of authority under section twenty of this article, levy an administrative penalty in an amount not less than $100 nor more than $5,000, if reasonable notice in writing is given of the intent to levy the penalty and the prepaid limited health […]

§33-25D-26. Scope of Provisions; Applicability of Other Laws

(a) Except as otherwise provided in this article, provisions of the insurance laws, provisions of hospital, medical, dental or health service corporation laws and provisions of health maintenance organization laws are not applicable to any prepaid limited health service organization granted a certificate of authority under this article. The provisions of this article do not […]

§33-25D-27. Filings and Reports as Public Documents

All applications, filings and reports required under this article are public documents: Provided, That where the provisions of other articles in this chapter are applicable to prepaid limited health service organizations, all applications, filings and reports required under those articles shall be afforded the level of confidentiality as provided in those articles.