§ 38-33-180 — Suspension or revocation of certificate of authority.

South Carolina § 38-33-180

• Jurisdiction: South Carolina
• Title 38: INSURANCE
• Ch. 33: HEALTH MAINTENANCE ORGANIZATIONS

Text

(A) The director or his designee may suspend or revoke a certificate of authority issued to a health maintenance organization if he finds that one or more of the following conditions exist: (1) The health maintenance organization is operating significantly in contravention of its basic organizational document or in a manner contrary to that described in other information submitted under Section 38-33-30, unless amendments to the submissions have been filed with and approved by the director or his designee. (2) 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 38-33-80. (3) The health maintenance organization does not provide or arrange for basic health care services. (4) The health maintenance organization does not meet the requirements of Section 38-33-40 or is unable to fulfill its obligations to furnish health care services. (5) The health maintenance organization is financially unsound or reasonably may be expected to be unable to meet its obligations to enrollees or prospective enrollees. (6) The health maintenance organization has failed to implement a mechanism affording the enrollees an opportunity to participate in matters of policy and operation under Section 38-33-60. (7) The health maintenance organization has failed to implement the complaint system required by Section 38-33-110 in a reasonable manner to resolve valid complaints. (8) The health maintenance organization, or a person on its behalf, advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner. (9) The continued operation of the health maintenance organization is hazardous to its enrollees. (10) The health maintenance organization otherwise has failed to comply with this chapter or regulations promulgated under it by the department. (B) A certificate of authority is suspended or revoked only after compliance with the requirements of Section 38-33-210. (C) When the certificate of authority of a health maintenance organization is suspended, the health maintenance organization, during the suspension, may not enroll additional enrollees except newborn children or other newly acquired dependents of existing enrollees and may not engage in advertising or solicitation. (D) When the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and may conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization. It may not engage in further advertising or solicitation. The director or his designee, by written order, may permit further operation of the organization he finds to be in the best interest of enrollees, to the end that enrollees are afforded the greatest practical opportunity to obtain continuing health care coverage.

Legislative History

HISTORY: Enacted as 1976 Code SECTION 38-25-180 by 1987 Act No. 83, SECTION 1; recodified as SECTION 38-33-180 by 1987 Act No. 155, SECTION 24; 1992 Act No. 403, SECTION 6; 1993 Act No. 181, SECTION 633.