TITLE 27
Insurance
CHAPTER 27-41
Health Maintenance Organizations
SECTION 27-41-35
§ 27-41-35 Enrollment period in the event
of insolvency.
(a) In the event of an insolvency of a health maintenance organization, upon
order of the director, all other carriers that participated in the enrollment
process with the insolvent health maintenance organization at a group's last
regular enrollment period shall offer the group's enrollees of the insolvent
health maintenance organization a thirty (30) day enrollment period commencing
upon the date of insolvency. Each carrier shall offer the enrollees of the
insolvent health maintenance organization the same coverage and rates that it
had offered to the enrollees of the group at its last regular enrollment period;
(b) If no other carrier had been offered to some groups
enrolled in the insolvent health maintenance organization, or if the director
determines that the other health benefit plan(s) lack(s) sufficient health care
delivery resources to assure that health care services will be available and
accessible to all of the group enrollees of the insolvent health maintenance
organization, then the director shall allocate equitably the insolvent health
maintenance organization's group contracts for the groups among all health
maintenance organizations which operate within a portion of the insolvent
health maintenance organization's service area, taking into consideration the
health care delivery resources of each health maintenance organization. If the
director determines that no health maintenance organization has sufficient
resources to assure that health care services will be available and accessible
to some groups enrolled in the insolvent health maintenance organization, then
the director shall allocate equitably the insolvent health maintenance
organization's contracts for the groups among the other carriers as he or she
deems appropriate. Each health maintenance organization, or other carrier, to
which a group or groups are so allocated shall offer the group or groups the
health maintenance organization's or other carrier's existing coverage which is
most similar to each group's coverage with the insolvent health maintenance
organization at rates determined in accordance with the successor health
maintenance organization's or other carrier's existing rating methodology;
(c) The director shall also allocate equitably the insolvent
health maintenance organization's nongroup enrollees that are unable to obtain
other coverage among all health maintenance organizations which operate within
a portion of the insolvent health maintenance organization's service area,
taking into consideration the health care delivery resources of each health
maintenance organization. If the director determines that no health maintenance
organization has sufficient resources to assure that health care services will
be available and accessible to some nongroup enrollees of the insolvent health
maintenance organization, then the director shall allocate equitably the
insolvent health maintenance organization's contracts for the nongroup
enrollees among the other carriers as he or she deems appropriate. Each health
maintenance organization or other carrier to which nongroup enrollees are
allocated shall offer the nongroup enrollees the health maintenance
organization's or other carrier's existing coverage for individual or
conversion coverage as determined by his or her type of coverage in the
insolvent health maintenance organization at rates determined in accordance
with the successor health maintenance organization's or other carrier's
existing rating methodology. Successor health maintenance organizations or
other carriers that do not offer direct nongroup enrollment may aggregate all
of the allocated nongroup enrollees into one group for rating and coverage
purposes.
History of Section.
(P.L. 1990, ch. 161, § 2.)