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CHAPTER 58-41

HEALTH MAINTENANCE ORGANIZATIONS

58-41-1      Definition of terms.
58-41-2      Organizations subject to chapter.
58-41-3      Certificate of authority required for health maintenance organization or contracts--Violation as misdemeanor.
58-41-4      Application for certificate of authority required.
58-41-5      Repealed.
58-41-6      Verification and form of application--Contents.
58-41-7      Financial statements required with application.
58-41-8      Copies of forms required with application.
58-41-9      Marketing, charges, and financial plans required with application.
58-41-10      Appointment to receive process required of foreign applicant.
58-41-11      Surety bond or deposit required--Waiver.
58-41-12      Determination of health care qualifications.
58-41-13      Coordination with federal professional standards review.
58-41-14      Obsolete.
58-41-15      Health maintenance not considered practice of healing arts.
58-41-15.1      Certain healing arts practitioners to participate in alternate health care delivery systems.
58-41-16      Repealed.
58-41-17      Issuance or denial of certificate--Fee--Conditions for issuance.
58-41-18      Factors considered in determining financial responsibility.
58-41-19      Insurance arrangements permitted.
58-41-20      Corporation operating after certification.
58-41-21      Foreign corporations qualifying--Exemption from other requirements.
58-41-22      Filing of notice of modification of operation--Approval if not disapproved--Exemptions.
58-41-23      Composition of governing body--Consumer representation.
58-41-24      Mechanisms for enrollee participation in policy and operation of governing body.
58-41-25      Fiduciary responsibilities to enrollees.
58-41-25.1      Investments.
58-41-26      Exemption from insurance laws--Exceptions--Taxation.
58-41-27      Repealed.
58-41-28      Solicitation of enrollment not deemed professional advertising.
58-41-29      Contracts and necessary activities.
58-41-29.1      Notice required for rate increase in health maintenance contract by a health maintenance organization.
58-41-30      Sources of payment for enrollee services--Application by medical assistance recipient.
58-41-31      Direct payments to enrollees prohibited.
58-41-32      Use of words descriptive of insurance, casualty, or surety business as misdemeanor--Exception.
58-41-33      Trade practice laws applicable.
58-41-34      Evidence of coverage issued to enrollees.
58-41-35      Contents required in evidence of coverage.
58-41-35.1      Alcoholism coverage to be offered at time contract is negotiated.
58-41-35.2 to 58-41-35.4.      Repealed.


58-41-35.5      Grandfathered contracts required to cover low-dose mammography--Extent of coverage.
58-41-35.6      Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony.
58-41-35.7      Contracts required to cover occult breast cancer screening.
58-41-36      Unfair and misleading information in evidence of coverage as misdemeanor.
58-41-37      Deceptive advertising or evidence of coverage as misdemeanor.
58-41-38      Statements deemed untrue.
58-41-39      Statements deemed misleading.
58-41-40      Evidence of coverage deemed deceptive.
58-41-41      Issuance to enrollees of change in evidence of coverage.
58-41-42      Evidence of coverage to be approved before use--Violation as misdemeanor.
58-41-43      Filing and approval requirements applicable.
58-41-44      Charges to enrollees--Fairness--Actuary's certificate.
58-41-45      Discrimination as misdemeanor.
58-41-46 to 58-41-49. Repealed.
58-41-50      Authorized expenses.
58-41-51      Repealed.
58-41-51.1      Individual policy required for covered spouse of insured--Eligibility--Coverage--Waiting periods.
58-41-51.2      Conversion privileges of insured's spouse upon divorce.
58-41-51.3      Continuation and conversion coverage to be offered.
58-41-52      Contracts with providers of health care services.
58-41-53      Repealed.
58-41-54      Contracts with insurance companies and nonprofit health service plan corporations authorized--Limitations.
58-41-55      Insurance contracts authorized--Group coverage--Benefit payments.
58-41-56      Contracts for management and administrative services authorized.
58-41-57      Payment of unreasonably high expenses as misdemeanor.
58-41-58 to 58-41-62.      Repealed.
58-41-63      General annual report required--Form and contents.
58-41-64      Repealed.
58-41-65      Applications, filings and reports as public documents.
58-41-66      Annual summary for enrollees required--Contents.
58-41-67      Promulgation of rules.
58-41-68 to 58-41-72. Repealed.
58-41-73      Physician-patient privileges.
58-41-74      Confidential data--Exceptions.
58-41-75, 58-41-76. Repealed.
58-41-77      Repealed.
58-41-78      Cease and desist orders.
58-41-79      Hearing on cease and desist order--Procedure--Judicial review.
58-41-80      Injunctive relief against violations--Venue.
58-41-81      Suspension or revocation of certificate of authority on findings by director.
58-41-82      Additional grounds for suspension or revocation.
58-41-83      Voluntary conference before commencing actions for violation.
58-41-84      Informality in voluntary conferences.
58-41-85      Money penalty in lieu of suspension or revocation.
58-41-86      Requirements for suspension or revocation.
58-41-86.1      Suspension without notice or hearing.
58-41-87      Notice of grounds for denial, suspension, or revocation of certificate--Time of hearing--Summary proceedings excepted.
58-41-88      Administrative procedure and rules.
58-41-89      Repealed.
58-41-90      Action of director after hearing--Written findings.
58-41-91      Judicial review.
58-41-92      Activities prohibited during suspension of certificate.
58-41-93      Winding up after revocation of certificate--Continued operation to protect enrollees.
58-41-94      Summary proceeding to reorganize organization--Grounds.
58-41-95      Rehabilitation, liquidation, or conservation under insurance company laws.
58-41-96      Severability of provisions.
58-41-97      Citation of chapter.
58-41-98      Coverage for phenylketonuria.
58-41-99      Formation of voluntary health insurance purchasing organizations.
58-41-100      Membership of voluntary health insurance purchasing organizations.
58-41-101      Purchasing organization's responsibility for negotiating terms and conditions.
58-41-102      Purchasing organization's notice of premium charge.
58-41-103      Additional chapters applicable to purchasing organization.
58-41-104      Approval of purchasing organization by Division of Insurance.
58-41-105      Premiums held in trust by purchasing organization.
58-41-106      Rates for group health insurance issued to purchasing organizations.
58-41-107      Reasonable participation requirements for group members of purchasing organizations.
58-41-108      Purchasing organizations exempt from antitrust provisions.
58-41-109      Promulgation of rules for purchasing organizations.
58-41-110      Application of chapter to provider contracting with state.
58-41-111      Application of chapter to provider contracting with licensed health maintenance organization.
58-41-112      Minimum inpatient care coverage following delivery.
58-41-113      Shorter hospital stay permitted--Follow-up visit within forty-eight hours required.
58-41-114      Notice to enrollees--Disclosures.
58-41-115      Health insurance policies to provide coverage for biologically-based mental illnesses.
58-41-116      Application--Exemptions.
58-41-117      Policies to provide coverage for diabetes supplies, equipment, and education--Exceptions--Conditions and limitations.
58-41-118      Diabetes coverage not required of certain plans and policies.
58-41-119      Contracts to provide coverage for prostate cancer screening.
58-41-120      Annual report on risk bearing entities.
58-41-121      Documents provided to risk bearing entity by health maintenance organization.
58-41-122      Documents provided to health maintenance organization by risk bearing entity.
58-41-123      Notice by risk bearing entity of change in conditions--Assignment of contract.
58-41-124      Notice to director that risk bearing entity has materially failed to perform contract.
58-41-125      Confidentiality of information.
58-41-126      Nontransferable responsibilities of health maintenance organization.
58-41-127      Coverage for treatment of hearing impairment for persons under age nineteen.


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