§ 36-6944 — Challenge of determination or action by Insurance

Commissioner - Required events - Hearing. Upon the occurrence of any of the events specified in this section, the health maintenance organization shall have the right to a confidential departmental hearing, on the record, at which time the health maintenance organization may challenge any determination or action by the Insurance Commissioner. The health maintenance organization shall notify the Commissioner of its request for a hearing within five (5) days after the notification by the Commissioner pursuant to the provisions of paragraph 1, 2, 3 or 4 of this section. Upon receipt of the health maintenance organization’s request for a hearing, the Commissioner shall set a date for the hearing, which shall be not less than ten (10), nor more than thirty (30) days after the date of the health maintenance organization’s request. The events include: 1. Notification to a health maintenance organization by the Commissioner of an adjusted Risk-Based Capital (RBC) report; 2. Notification to a health maintenance organization by the Commissioner that: a. the health maintenance organization’s RBC plan or revised RBC plan is unsatisfactory, and b. notification constitutes a Regulatory Action Level Event with respect to the health maintenance organization; 3. Notification to a health maintenance organization by the Commissioner that the health maintenance organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health maintenance organization to eliminate the Company Action Level Event with respect to the health maintenance organization in accordance with its RBC plan or revised RBC plan; or 4. Notification to a health maintenance organization by the Commissioner of a corrective order with respect to the health maintenance organization.

Legislative History

Added by Laws 2003, c. 197, § 44, eff. Nov. 1, 2003.