§ 26-34-121 — Suspension or revocation of certificate of authority

(a) The commissioner may suspend or revoke any certificate
of authority issued to a health maintenance organization under
this chapter if:
(i) The commissioner finds the health maintenance
organization:
(A) Is operating significantly in contravention
of its basic organizational document or in a manner contrary to
that described in any other information submitted under W.S.
26-34-103, unless amendments to those submissions have been
filed with and approved by the commissioner;
(B) Issues evidence of coverage or uses a
schedule of premiums for health care services which do not
comply with W.S. 26-34-109;
(C) Does not provide or arrange for basic or
nonbasic health care services;
(D) Is no longer financially responsible and is
reasonably expected to be unable to meet its obligations to
enrollees or prospective enrollees;
(E) Has failed to correct, within the time
prescribed by subsection (c) of this section, any deficiency
occurring due to the health maintenance organization's
prescribed minimum net worth being impaired;
(F) Has failed to implement the complaint system
required by W.S. 26-34-112 in a reasonable manner to resolve
valid complaints;
(G) Any person on its behalf, has advertised or
merchandised its services in an untrue, misrepresentative,
misleading, deceptive or unfair manner; or
(H) Has otherwise failed substantially to comply
with this chapter.
(ii) The administrator certifies to the commissioner
that the health maintenance organization either does not meet
the requirements of W.S. 26-34-104(b) or is unable to fulfill
its obligations to furnish health care services;
(iii) The commissioner finds the continued operation
of the health maintenance organization would be hazardous to its
enrollees. The commissioner may consider the factors specified
in W.S. 26-3-116(c) and 26-3-132(a) when making this finding.
(b) In addition to or in lieu of suspension or revocation
of a certificate of authority pursuant to this section, the
applicant or health maintenance organization may be subjected to
an administrative penalty of up to ten thousand dollars
($10,000.00) for each cause for suspension or revocation.
(c) Whenever the commissioner finds that the net worth
maintained by any health maintenance organization subject to the
provisions of this act is less than the minimum net worth
required to be maintained by W.S. 26-34-114, he shall give
written notice to the health maintenance organization of the
amount of the deficiency and require:
(i) Filing with the commissioner a plan for
correction of the deficiency acceptable to the commissioner; and
(ii) Correction of the deficiency within a reasonable
time, not to exceed sixty (60) days, unless an extension of
time, not to exceed sixty (60) additional days, is granted by
the commissioner.
(d) A deficiency shall be deemed an impairment, and
failure to correct the impairment in the prescribed time shall
be grounds for suspension or revocation of the certificate of
authority or for placing the health maintenance organization in
conservation, rehabilitation or liquidation.
(e) Unless allowed by the commissioner, no health
maintenance organization or person acting on its behalf may,
directly or indirectly, renew, issue or deliver any certificate,
agreement or contract of coverage in this state, for which a
premium is charged or collected, when the health maintenance
organization writing the coverage is impaired, and the
impairment is known to the health maintenance organization or to
the person. However, the existence of an impairment shall not
prevent the issuance or renewal of a certificate, agreement or
contract when the enrollee exercises an option granted under the
plan to obtain a new, renewed or converted coverage.
(f) A certificate of authority shall be suspended or
revoked, or an administrative penalty levied pursuant to
subsection (b) of this section, only after compliance with W.S.