§ 10-16-417 — Suspension or revocation of certificate of authority

Colorado § 10-16-417

• Jurisdiction: Colorado
• Title 10: Insurance
• Art.: Health-care Coverage

Text

(1) The
commissioner may suspend or revoke any certificate of authority issued to a health
maintenance organization pursuant to part 1 of this article 16 and this part 4 if the
commissioner finds that any of the following conditions exist:

(a) The health maintenance organization is operating significantly in
contravention of its basic organizational document, its health-care plan, or in a
manner contrary to that described in and reasonably inferred from any other
information submitted pursuant to section 10-16-401, unless amendments to such
submissions have been filed with and approved by the commissioner;

(b) The health maintenance organization issues evidence of coverage or uses
a schedule of charges for health-care services which do not comply with the
requirements of section 10-16-406;

(c) The health-care plan does not provide or arrange for basic health-care
services;

(d) The commissioner determines that:

(I) The health maintenance organization does not meet the requirements of
section 10-16-402 (1)(b); or

(II) The health maintenance organization is unable to fulfill its obligations to
furnish health-care services as required under its health-care plan;

(e) The health maintenance organization is no longer financially responsible
and may reasonably be expected to be unable to meet its obligations to enrollees
or prospective enrollees;

(f) The health maintenance organization has failed to implement a
mechanism affording the enrollees an opportunity to participate in matters of
policy and operation pursuant to section 10-16-404;

(g) The health maintenance organization has failed to implement the
complaint system required by section 10-16-409 in a manner to reasonably resolve
valid complaints;

(h) The health maintenance organization, or any person on its behalf, has
advertised or merchandised its services in an untrue, misrepresentative, misleading,
deceptive, or unfair manner;

(i) The continued operation of the health maintenance organization would be
hazardous to its enrollees;

(j) The health maintenance organization has otherwise failed to substantially
comply with part 1 of this article or this part 4.

(2) A certificate of authority shall be suspended or revoked only after
compliance with the requirements of section 10-16-419.

(3) When the certificate of authority of a health maintenance organization is
suspended, the health maintenance organization shall not, during the period of such
suspension, enroll any additional enrollees except newborn children or other newly
acquired dependents of existing enrollees, and shall not engage in any advertising
or solicitation whatsoever.

(4) When the certificate of authority of a health maintenance organization is
revoked, such organization shall proceed, immediately following the effective date
of the order of revocation, to wind up its affairs, and shall conduct no further
business except as may be essential to the orderly conclusion of the affairs of such
organization. It shall engage in no further advertising or solicitation whatsoever.
The commissioner may, by written order, permit such further operation of the
organization as the commissioner may find to be in the best interest of enrollees, to
the end that enrollees will be afforded the greatest practical opportunity to obtain
continuing health-care coverage.

Legislative History

Source: L. 92: Entire article R&RE, p. 1708, � 1, effective July 1. L. 2017: IP(1) and (1)(d) amended, (SB 17-249), ch. 283, p. 1546, � 10, effective June 1.