§ 10-16-408 — Open enrollment

(1) After a health maintenance organization
has been in operation twenty-four months, it shall have an annual open enrollment
period of at least one month during which it accepts enrollees up to the limits of its
capacity, as determined by the health maintenance organization, in the order in
which they apply for enrollment. A health maintenance organization may apply to
the commissioner for authorization to impose such underwriting restrictions upon
enrollment as are necessary to preserve its financial stability, to prevent excessive
adverse selection by prospective enrollees, or to avoid unreasonably high or
unmarketable charges for enrollee coverage for health-care services. The
commissioner shall approve or deny such application within thirty days of the
receipt thereof from the health maintenance organization.

(2) Health maintenance organizations providing or arranging for services
exclusively on a group contract basis may limit the open enrollment provided for in
subsection (1) of this section to all members of the group or groups covered by such
contracts.

(3) Except as provided in subsection (2) of this section, the enrollment
policies of health maintenance organizations may not be such as to prevent or
hinder the enrollment by, or in any other manner discriminate against, persons
eligible for medical benefits under Titles XVIII and XIX of the federal Social
Security Act as authorized under Public Law 89-97; such policies shall be grounds
for suspension or revocation of the organization's certificate of authority issued
pursuant to this article.

Legislative History

Source: L. 92: Entire article R&RE, p. 1701, � 1, effective July 1.