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§27-41-35  Enrollment period in the event of insolvency. –


Published: 2015

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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.)