§ 26.1-18.1-04 — Powers of health maintenance organizations

North Dakota § 26.1-18.1-04

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-18.1: Health Maintenance Organizations

Text

1. The powers of a health maintenance organization include the following:
a. The purchase, lease, construction, renovation, operation, or maintenance of
hospitals, medical facilities, or both, and their ancillary equipment, and such
property as may reasonably be required for its principal office or for such
purposes as may be necessary in the transaction of the business of the
organization.
b. Transactions between affiliated entities, including loans and the transfer of
responsibility under all contracts between affiliates or between the health
maintenance organization and its parent.
c. The furnishing of health care services through providers, provider associations, or
agents for providers which are under contract with or employed by the health
maintenance organization.
d. The contracting with any person for the performance on its behalf of certain
functions such as marketing, enrollment, and administration.
e. The contracting with an insurance company licensed in this state, or with a
hospital or medical service corporation authorized to do business in this state, for
the provision of insurance, indemnity, or reimbursement against the cost of health
care services provided by the health maintenance organization.
f. The offering of other health care services, in addition to basic health care
services. Nonbasic health care services may be offered by a health maintenance
organization on a prepaid basis without offering basic health care services to any
group or individual.
g. The joint marketing of products with an insurance company licensed in this state
or with a hospital or medical service corporation authorized to do business in this
state as long as the company that is offering each product is clearly identified.
2. a. A health maintenance organization shall file notice, with adequate supporting
information, with the commissioner prior to the exercise of any power granted in
subdivisions a, b, and d of subsection 1 which may affect the financial soundness
of the health maintenance organization. The commissioner shall disapprove the
exercise of power only if in the commissioner's opinion it would substantially and
adversely affect the financial soundness of the health maintenance organization
and endanger its ability to meet its obligations.

b. The commissioner may adopt rules exempting from the filing requirement of
subdivision a those activities having a de minimis effect.