83-41-309 - Powers of health maintenance organization generally; notice of exercise of powers affecting financial condition of organization.
§ 83-41-309. Powers of health maintenance organization generally; notice of exercise of powers affecting financial condition of organization.
(1) The powers of a health maintenance organization include, but are not limited to, the following:
(a) 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 transaction of the business of the organization;
(b) Transactions between affiliated entities, including loans and the transfer of responsibility under all contracts between affiliates loans from the health maintenance organization to a parent are prohibited without prior approval in writing from the commissioner;
(c) The furnishing of health care services through providers, provider associations or agents for providers which are under contract with or employed by the health maintenance organization;
(d) The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration provided all entities are qualified under this article;
(e) The contracting with an insurance company licensed in this state, or with a hospital or medical service corporation authorized to do business in this state, for the provision of insurance, indemnity or reimbursement against the cost of health care services provided by the health maintenance organization;
(f) The offering of other health care services, in addition to basic health care services. Non-basic health care services may be offered by a health maintenance organization on a prepaid basis without offering basic health care services to any group or individual;
(g) The joint marketing of products with an insurance company licensed in this state or with a hospital or medical service corporation authorized to do business in this state as long as the company that is offering each product is clearly identified.
(2) (a) A health maintenance organization shall file notice, with adequate supporting information, with the commissioner prior to the exercise of any power granted in subsection 1(a), (b) or (d) which may affect the financial condition of the health maintenance organization. The commissioner shall disapprove an exercise of power only if in his opinion it would substantially and adversely affect the financial condition of the health maintenance organization and endanger its ability to meet its obligations.
(b) The commissioner may promulgate rules and regulations exempting from the filing requirement of paragraph (a) those activities having a de minimis effect.
Sources: Laws, 1995, ch. 613, § 5, eff from and after July 1, 1995.