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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    58-41-5. Repealed by SL 1985, ch 393, § 7

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    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    58-41-16. Repealed by SL 2013, ch 256, § 7.

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    58-41-27. Repealed by SL 1985, ch 393, § 9

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    58-41-35.2 to 58-41-35.4. Repealed by SL 2001, ch 274, §§ 10 to 12

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    58-41-46 to 58-41-49. Repealed by SL 2013, ch 256, §§ 12 to 15.

58-41-50    Authorized expenses.

58-41-51    58-41-51. Repealed by SL 2013, ch 256, § 16.

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.

58-41-52.1    Collection for covered services prohibited.

58-41-52.2    Contracts--Hold harmless provision.

58-41-52.3    Hold harmless provision--Language of provision.

58-41-53    58-41-53. Repealed by SL 1999, ch 245, § 21

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    58-41-58 to 58-41-62. Repealed by SL 1996, ch 296, §§ 9 to 13

58-41-63    General annual report required--Form and contents.

58-41-64    58-41-64. Repealed by SL 1985, ch 393, § 10

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    58-41-68 to 58-41-72. Repealed by SL 2013, ch 256, §§ 20 to 24.

58-41-73    Physician-patient privileges.

58-41-74    Confidential data--Exceptions.

58-41-75    58-41-75, 58-41-76. Repealed by SL 2013, ch 256, §§ 25, 26.

58-41-77    58-41-77. Repealed by SL 1978, ch 359, § 3

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    58-41-89. Repealed by SL 2013, ch 256, § 32.

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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