§ 23-75-111 - Subscription contracts.
23-75-111. Subscription contracts.
(a) (1) All rates charged by the corporation to subscribers or classes of subscribers having contracts covered by 23-85-101 -- 23-85-131, and the form and content of all contracts between the corporation and its subscribers, classes of subscribers, or groups of subscribers, and the certificates issued by the corporation representing their subscribers' agreements shall be subject at all times to the prior approval of the Insurance Commissioner.
(2) Application for approval shall be made to the commissioner in such form and shall set forth such information as the commissioner may require.
(3) Rates shall not be excessive, inadequate, or unfairly discriminatory in relation to the services offered.
(4) (A) Upon the commissioner's review of an application at any time, if the applicant requests a hearing, the commissioner shall hold a hearing before issuing an order of disapproval. The applicant shall be given not less than ten (10) days' written notice of the hearing. The notice shall specify the matters to be considered at the hearing.
(B) If after the hearing provided by subdivision (a)(4)(A) of this section the commissioner finds that the application or a part thereof does not meet the requirements of this code, the commissioner shall issue an order specifying in what respects he or she finds that it fails. Notice thereof shall immediately be served on the applicant, either personally or by mail. Within thirty (30) days after the date of such a notice, the applicant may apply to the Pulaski County Circuit Court to show cause why the action of the commissioner should be set aside and the application approved.
(b) (1) In any hospital service corporation contract, any medical service corporation contract, or any hospital and medical service corporation contract, whether group or individual, that contains a provision whereby coverage of a dependent in a family group terminates at a specified age, there shall also be a provision that coverage of an unmarried dependent who is incapable of sustaining employment by reason of mental retardation or physical disability, who became so incapacitated prior to the attainment of nineteen (19) years of age and who is chiefly dependent upon the contract holder or certificate holder for support and maintenance, shall not terminate, but coverage shall continue so long as the contract or certificate remains in force and so long as the dependent remains in such a condition.
(2) At the request and expense of the corporation, proof of the incapacity and dependency must be furnished to the corporation by the contract or certificate holder at least thirty-one (31) days before the child's attainment of the limiting age, and, subsequently, as may be required by the corporation, but not more frequently than annually, after the two-year period following the child's attainment of the limiting age.
(c) (1) Each contract shall plainly state the services to which the subscriber is entitled and those to which the subscriber is not entitled under the plan.
(2) As to benefits provided on a service, instead of cash indemnity basis, the contract shall constitute a direct obligation of the hospitals and physicians with which or with whom the corporation has contracted for hospital or medical services.
(3) A copy of the contract shall be delivered to the subscriber.
(d) (1) The commissioner shall review filings as soon as reasonably possible after they have been made in order to determine whether they meet the requirements of this chapter.
(2) Each filing shall be on file for a waiting period of thirty (30) days before it becomes effective. The period may be extended by the commissioner for an additional period not to exceed thirty (30) days if the commissioner gives written notice within the waiting period to the insurer which made the filing that the commissioner needs such additional time for the consideration of the filing.
(3) Upon written application by the insurer, the commissioner may authorize a filing which the commissioner has reviewed to become effective before the expiration of the waiting period or any extension thereof.
(4) A filing shall be deemed to meet the requirements of this chapter unless disapproved by the commissioner within the waiting period or any extension thereof.