HEALTH MAINTENANCE ORGANIZATIONS
Definition of terms.
Organizations subject to chapter.
Certificate of authority required for health maintenance organization or
contracts--Violation as misdemeanor.
Application for certificate of authority required.
Verification and form of application--Contents.
Financial statements required with application.
Copies of forms required with application.
Marketing, charges, and financial plans required with application.
Appointment to receive process required of foreign applicant.
Surety bond or deposit required--Waiver.
Transmittal of application to secretary of health--Determination of health
Coordination with federal professional standards review.
Health maintenance not considered practice of healing arts.
Certain healing arts practitioners to participate in alternate health care
Certification as to meeting health care requirements--Deficiencies
Time for issuance or denial of certificate--Fee--Conditions for issuance.
Factors considered in determining financial responsibility.
Insurance arrangements permitted.
Corporation operating after certification.
Foreign corporations qualifying--Exemption from other requirements.
Filing of notice of modification of operation--Approval if not
Composition of governing body--Required consumer representation.
Mechanisms for enrollee participation in policy and operation of
Fiduciary responsibilities to enrollees.
Exemption from insurance laws--Taxation.
Solicitation of enrollment not deemed professional advertising.
Contracts and necessary activities.
Notice required for rate increase in health maintenance contract by a
health maintenance organization.
Sources of payment for enrollee services--Application by medical
Direct payments to enrollees prohibited.
Use of words descriptive of insurance, casualty, or surety business as
Trade practice laws applicable.
Evidence of coverage issued to enrollees.
Contents required in evidence of coverage.
Alcoholism coverage to be offered at time contract is negotiated.
Grandfathered contracts required to cover low-dose mammography--Extent of coverage.
Exclusion of benefits for injury while under the influence of alcohol or
drugs prohibited--Exception for sickness or injury caused in commission
Contracts required to cover occult breast cancer screening.
Unfair and misleading information in evidence of coverage as
Deceptive advertising or evidence of coverage as misdemeanor.
Statements deemed untrue.
Statements deemed misleading.
Evidence of coverage deemed deceptive.
Issuance to enrollees of change in evidence of coverage.
Evidence of coverage to be approved before use--Violation as
Filing and approval requirements applicable.
Charges to enrollees--Fairness--Actuary's certificate.
Discrimination as misdemeanor.
Filing and approval of schedule of charges required--Exception for
employer sponsored plan.
Approval of forms and schedules--Time.
Notice of disapproval of filing--Request for hearing.
Information required by director.
Cancellation or nonrenewal of coverage--Grounds--Notice--Violation as
Individual policy required for covered spouse of insured--Eligibility--Coverage--Waiting periods.
Conversion privileges of insured's spouse upon divorce.
Continuation and conversion coverage to be offered.
Contracts with providers of health care services.
Contracts with insurance companies and nonprofit health service plan
Insurance contracts authorized--Group coverage--Benefit payments.
Contracts for management and administrative services authorized.
Payment of unreasonably high expenses as misdemeanor.
General annual report required--Form and contents.
Applications, filings and reports as public documents.
Annual summary for enrollees required--Contents.
Rules--Minimum services and permissible exclusions.
Periodic examination of activities.
Examination of finances and provider agreements--Minimum frequency.
Examination of health care services--Minimum frequency.
Investigative powers of director and secretary.
Administration of oaths--Subpoena power.
Assessment of examination expense.
Examination report from another state.
Cease and desist orders.
Hearing on cease and desist order--Procedure--Judicial review.
Injunctive relief against violations--Venue.
Suspension or revocation of certificate of authority on findings by
Suspension or revocation on grounds certified by secretary of health.
Voluntary conference before commencing actions for violation.
Informality in voluntary conferences.
Money penalty in lieu of suspension or revocation.
Requirements for suspension or revocation.
Suspension without notice or hearing.
Notice of grounds for denial, suspension, or revocation of certificate--Time of hearing--Summary proceedings excepted.
Administrative procedure and rules.
Participation of health department in hearings--Findings on health care
Action of directors after hearing--Written findings.
Judicial review--Power of court.
Activities prohibited during suspension of certificate.
Winding up after revocation of certificate--Continued operation to
Summary proceeding to reorganize organization--Grounds.
Rehabilitation, liquidation, or conservation under insurance company
Severability of provisions.
Citation of chapter.
Coverage for phenylketonuria.
Formation of voluntary health insurance purchasing organizations.
Membership of voluntary health insurance purchasing organizations.
Purchasing organization's responsibility for negotiating terms and
Purchasing organization's notice of premium charge.
Additional chapters applicable to purchasing organization.
Approval of purchasing organization by Division of Insurance.
Premiums held in trust by purchasing organization.
Rates for group health insurance issued to purchasing organizations.
Reasonable participation requirements for group members of purchasing
Purchasing organizations exempt from antitrust provisions.
Promulgation of rules for purchasing organizations.
Application of chapter to provider contracting with state.
Application of chapter to provider contracting with licensed health
Minimum inpatient care coverage following delivery.
Shorter hospital stay permitted--Follow-up visit within forty-eight hours
Notice to enrollees--Disclosures.
Health insurance policies to provide coverage for biologically-based
Policies to provide coverage for diabetes supplies, equipment, and
education--Exceptions--Conditions and limitations.
Diabetes coverage not required of certain plans and policies.
Contracts to provide coverage for prostate cancer screening.