§ 23-76-123 - Suspension or revocation of certificate of authority.
23-76-123. Suspension or revocation of certificate of authority.
(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 health care plan, or in a manner contrary to that described in and reasonably inferred from any other information submitted under 23-76-107, unless amendments to the submissions have been filed with and approved by the commissioner;
(2) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of 23-76-112;
(3) The health care plan does not provide or arrange for basic health care services;
(4) The Director of the Department of Health certifies to the commissioner that:
(A) The health maintenance organization does not meet the requirements of 23-76-108(a)(2); or
(B) The health maintenance organization is unable to fulfill its obligations to furnish health care services as required under its health care plan;
(5) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;
(6) The health maintenance organization has failed to implement a mechanism affording the enrollees an opportunity to participate in matters of policy and operation under 23-76-110;
(7) The health maintenance organization has failed to implement the complaint system required by 23-76-116 in a manner to reasonably resolve valid complaints;
(8) The health maintenance organization, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;
(9) The continued operation of the health maintenance organization would be hazardous to its enrollees; or
(10) The health maintenance organization has otherwise failed to substantially comply with this chapter.
(b) A certificate of authority shall be suspended or revoked only after compliance with the requirements of 23-76-126.
(c) When the certificate of authority of a health maintenance organizations suspended, during the period of the suspension the health maintenance organization shall not:
(1) Enroll any additional enrollees except newborn children or other newly acquired dependents of existing enrollees; and
(2) Engage in any advertising or solicitation whatsoever.
(d) (1) When the certificate of authority of a health maintenance organization is revoked, the organization shall:
(A) Proceed to wind up its affairs immediately following the effective date of the order of revocation;
(B) Conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization; and
(C) Engage in no further advertising or solicitation whatsoever.
(2) By written order, the commissioner may permit the further operation of the organization as the commissioner may find to be in the best interest of enrollees, to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing health care coverage.