§ 27-13-24-1 — Grounds for suspension or revocation

Indiana § 27-13-24-1

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 24: Suspension, Revocation, or Denial of Certificate of

Text

(a) The commissioner may suspend or revoke
a certificate of authority issued under this article or deny an application
submitted under this article if the commissioner finds that any of the
following conditions exists:
(1) The health maintenance organization is operating:
(A) significantly in contravention of its basic organizational
document; or
(B) in a manner contrary to that described in any other
information submitted under IC 27-13-2;
unless amendments to the basic organizational document or other
submissions that are consistent with the operations of the
organization have been filed with and approved by the
commissioner.
(2) The health maintenance organization:
(A) issues an evidence of coverage;
(B) enters into a contract with a participating provider; or
(C) uses a schedule of charges for health care services;
that does not comply with the requirements of IC 27-13-7, IC 27-13-15, and IC 27-13-20.
(3) The health maintenance organization does not provide or
arrange for basic health care services.
(4) The commissioner determines that the health maintenance
organization is unable to fulfill its obligations to furnish health
care coverage.
(5) 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.
(6) The health maintenance organization has failed to correct,
within the time prescribed by section 2 of this chapter, any
deficiency occurring due to the impairment of the prescribed
minimum net worth of the health maintenance organization.
(7) The health maintenance organization has failed to implement
the grievance procedures required by IC 27-13-10 in a reasonable
manner to resolve valid complaints.
(8) The health maintenance organization or any person acting on
behalf of the organization has intentionally advertised or
merchandised the services of the organization in an untrue, a
misrepresentative, a misleading, a deceptive, or an unfair manner.
(9) The continued operation of the health maintenance
organization would be hazardous to the enrollees of the
organization.
(10) The health maintenance organization fails to comply with the
requirements provided under IC 27-13-36 through IC 27-13-40.
(11) The health maintenance organization has otherwise failed
substantially to comply with this article.
(b) The commissioner, in a proceeding under IC 4-21.5-3-8, may
impose a civil penalty of not more than twenty-five thousand dollars
($25,000) against a health maintenance organization for each cause
listed in subsection (a). The civil penalties may not exceed one hundred
thousand dollars ($100,000) for any one (1) health maintenance
organization in one (1) calendar year. The penalty may be imposed in
addition to or instead of a suspension or revocation of the certificate of
authority of the health maintenance organization.

Legislative History

As added by P.L.26-1994, SEC.25. Amended by P.L.69-1998, SEC.10.