(a)Such hospital service corporation shall be a nonprofit sharing corporation without capital stock. It shall be maintained and operated solely for the benefit of the subscribers thereof and shall not be authorized to pay money in lieu of hospital service. A person, partnership, association, or corporation shall not contract to furnish hospital service unless authorized so to do pursuant to the provisions of this chapter. Corporations formed under the provisions of this chapter shall have the privileges and be subject to the provisions of Title 11B as well as the applicable provisions of this chapter. In the event of a conflict between the provisions of Title 11B and the provisions of this chapter, the latter shall control.
(b)Subject to the approval of the Commissioner or the Green Moun
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(a) Such hospital service corporation shall be a nonprofit sharing corporation without capital stock. It shall be maintained and operated solely for the benefit of the subscribers thereof and shall not be authorized to pay money in lieu of hospital service. A person, partnership, association, or corporation shall not contract to furnish hospital service unless authorized so to do pursuant to the provisions of this chapter. Corporations formed under the provisions of this chapter shall have the privileges and be subject to the provisions of Title 11B as well as the applicable provisions of this chapter. In the event of a conflict between the provisions of Title 11B and the provisions of this chapter, the latter shall control.
(b) Subject to the approval of the Commissioner or the Green Mountain Care Board established in 18 V.S.A. chapter 220, as appropriate, a hospital service corporation may establish, maintain, and operate a medical service plan as defined in section 4583 of this title. The Commissioner or the Board may refuse approval if the Commissioner or the Board finds that the rates submitted are excessive, inadequate, or unfairly discriminatory, fail to protect the hospital service corporation’s solvency, or fail to meet the standards of affordability, promotion of quality care, and promotion of access pursuant to section 4026 of this title. The contracts of a hospital service corporation that operates a medical service plan under this subsection shall be governed by chapter 125 of this title to the extent that they provide for medical service benefits, and by this chapter to the extent that the contracts provide for hospital service benefits.
(c) Subject to the approval of the Commissioner, a hospital or medical service corporation may establish, maintain, and operate, or participate in the establishment, maintenance, and operation of, health care services contracts or arrangements, including health maintenance organizations authorized pursuant to chapter 139 of this title, all of which are intended to ensure that subscriber benefits are provided at minimum cost under efficient and economical management. A health maintenance organization established, maintained, or operated under the authority of this subsection shall be organized so that its business and affairs will be managed by a governing board or committee of which a majority are members who are not providers, as those terms are defined in section 5101 of this title. Notwithstanding the foregoing, subject to the approval of the Commissioner, a hospital or medical service corporation may establish, maintain, and operate or participate in the establishment, maintenance, and operation of administrative claims processing services and related services.
(Amended 1975, No. 69, § 1, eff. April 18, 1975; 1985, No. 44; 1997, No. 54, §§ 2, 3, eff. June 26, 1997; 2005, No. 36, § 20, eff. June 1, 2005; 2011, No. 48, § 15a, eff. Jan. 1, 2012; 2013, No. 79, § 5f, eff. Jan. 1, 2014; 2025, No. 11, § 4, eff. September 1, 2025.)