§ 27-13-34-20 — Suspension or revocation of certificate of authority

Indiana § 27-13-34-20

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 34: Limited Service Health Maintenance Organizations

Text

(a) The commissioner may suspend or
revoke the certificate of authority issued to a limited service health
maintenance organization under this chapter or deny an application
submitted under this chapter upon determining that any of the
following conditions exist:
(1) The limited service health maintenance organization is
operating:
(A) significantly in contravention of the basic organizational
document of the organization; or
(B) in a manner contrary to that described in and reasonably
inferred from any other information submitted under section 8
of this chapter;
unless amendments to the organization's submissions have been
filed and authorized under section 11 of this chapter.
(2) The limited service health maintenance organization issues an
evidence of coverage that does not comply with the requirements
of section 13 of this chapter.
(3) The limited service health maintenance organization is unable
to fulfill its obligations to furnish limited health services.
(4) The limited service health maintenance organization is not
financially responsible and may reasonably be expected to be
unable to meet its obligations to enrollees or prospective
enrollees.
(5) The net worth of the limited service health maintenance
organization is less than that required by section 16 of this
chapter, or the limited service health maintenance organization
has failed to correct any deficiency in its net worth as required by
the commissioner.
(6) The limited service health maintenance organization has failed
to implement in a reasonable manner the grievance system
required by IC 27-13-10.
(7) The continued operation of the limited service health
maintenance organization would be hazardous to the enrollees of
the organization.
(8) The limited service health maintenance organization has
otherwise failed to comply with this chapter.
(b) The commissioner may suspend or revoke a certificate of
authority or deny an application for a certificate of authority by written
order sent to the limited service health maintenance organization by
certified mail or registered mail. The written order shall state the
grounds for the suspension, revocation, or denial. A limited service
health maintenance organization may request in writing a hearing
within thirty (30) days after mailing of the order. If the limited service
health maintenance organization requests a hearing within the time
specified, the commissioner shall hold a hearing, which may not be less
than twenty (20) days or more than sixty (60) days after the date of the
notice for a hearing on the matter under IC 4-21.5.
(c) Immediately after the certificate of authority of a limited service
health maintenance organization is revoked, the organization shall
proceed to wind up its affairs. An organization whose certificate is
revoked:
(1) shall not conduct further business except as may be essential
to the orderly conclusion of the affairs of the organization; and
(2) shall not engage in further advertising or solicitation.
However, the commissioner may, by written order, permit the 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 limited health
services.

Legislative History

As added by P.L.26-1994, SEC.25.