Title 21 — Insurance
53 chapters · 1,244 sections in this title.
AS 21.86.010 Establishment of health maintenance organizations.
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(a) A person may apply to the director for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. A person may not establish or operate a health maintenance organization in this state unless the person obt…
AS 21.86.020 Issuance of certificate of authority; approval of changes.
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(a) Within 10 days after receipt of an application for a certificate of authority, the director shall forward a copy of the application to the commissioner of health. Within 60 days after the commissioner of health receives the copy of the application, the commissioner shall make…
AS 21.86.030 Powers of a health maintenance organization.
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(a) A health maintenance organization may (1) purchase, lease, construct, renovate, operate, or maintain hospitals, other health care facilities, their ancillary equipment, and property reasonably required for its principal office or for purposes necessary in the transaction of t…
AS 21.86.040 Governing body; enrollee participation.
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(a) The governing body of a health maintenance organization may include providers, or other individuals, or both. At least one-third of the governing body must consist of consumers who are substantially representative of enrollees. (b) The governing body of a health maintenance o…
AS 21.86.045 Biographical affidavits.
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A domestic health maintenance organization shall file with the director a complete affidavit of biographical information not later than 30 days after the appointment of an officer or member of the governing body of the organization. If requested by the director, a foreign health …
AS 21.86.050 Fiduciary responsibility.
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(a) A director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests money in connection with the activities of that organization is responsible for that money in a fiduciary relationship to the organization. (b) A healt…
AS 21.86.060 Provision of services.
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(a) A health maintenance organization may provide provider services directly, through provider employees, or may provide the services under arrangements with individual providers or one or more groups of providers. (b) In addition to basic health care services, a health maintenan…
AS 21.86.070 Evidence of coverage; charges for health care services.
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(a) An enrollee residing in this state is entitled to evidence of coverage. If an enrollee obtains coverage from an insurance policy or from a subscriber contract issued by a hospital or medical service corporation, whether by option or otherwise, the insurer or hospital or medic…
AS 21.86.075 Chiropractic health care services.
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(a) An enrollee may use the services of a licensed chiropractor of the enrollee's choosing and may not be required to obtain the prior approval of the enrollee's health maintenance organization, a gatekeeper, or primary care physician. Within 10 days after an enrollee's first vis…
AS 21.86.078 Choice of health care provider.
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(a) A health maintenance organization shall offer to every enrollee a point-of-service plan option that would allow a covered person to receive covered services from an out-of-network health care provider without obtaining a referral or prior authorization from the health mainten…
AS 21.86.080 Annual statement; additional reports.
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(a) A health maintenance organization shall file an annual statement with the director under AS 21.09.200 and shall provide a copy to the commissioner of health. The annual statement shall be verified by at least two principal officers of the organization. The director may requir…
AS 21.86.087 [Renumbered as AS 21.06.087.]
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[Repealed or reserved.]
AS 21.86.090 Information to enrollees.
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A health maintenance organization shall promptly notify its enrollees of a material change in its operation that would directly affect the enrollees.
AS 21.86.100 Complaint system; report.
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(a) A health maintenance organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by its enrollees. A complaint system must provide a procedure for forwarding to the commissioner of health a d…
AS 21.86.110 Recovery of health care costs.
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If a health maintenance organization determines that an enrollee has received health care services that the enrollee is not entitled to receive under the terms of the health maintenance agreement, the organization may not recover an amount above the actual cost of providing the h…
AS 21.86.120 Return of agreement.
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A person who enters into a health maintenance agreement may return the agreement to the health maintenance organization or the agent from whom it was purchased within 10 days of the delivery of the agreement to the person if the person is not satisfied for any reason. Upon return…
AS 21.86.130 Investments.
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With the exception of investments made under AS 21.86.030, a health maintenance organization's money may only be invested as allowed by AS 21.21 for the investment of legal reserves of a life insurer.
AS 21.86.140 Protection against insolvency.
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(a) Except as otherwise provided in this section, a health maintenance organization shall deposit with the director, or with an organization or trustee acceptable to the director through which a custodial or controlled account is used, cash, securities, or a combination of these …
AS 21.86.150 Prohibited practices.
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(a) A health maintenance organization or a representative of a health maintenance organization may not cause or knowingly permit a person to provide, on behalf of the health maintenance organization, health care services that the person is not licensed to provide. (b) A health ma…
AS 21.86.160 Regulation of agents.
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(a) The director may adopt regulations necessary to provide for the licensing of health maintenance organization agents. (b) The director may, by regulation, exempt certain classes of persons from the requirement of obtaining an agent license if (1) the function the class perform…
AS 21.86.170 Powers of insurers and of hospital or medical service corporations.
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(a) An insurer licensed in this state, or a hospital or medical service corporation authorized to do business in this state, may, either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization under the provisions of this chapter. Two…
AS 21.86.180 Examinations.
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(a) The director shall examine the affairs and transactions of a health maintenance organization in the same manner as prescribed for an insurer in AS 21.06.140 — 21.06.180. (b) As often as is reasonably necessary for the protection of the interests of the people of the state, bu…
AS 21.86.190 Suspension or revocation of certificate of authority.
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(a) After compliance with AS 21.86.200, the director may suspend or revoke a certificate of authority issued to a health maintenance organization under this chapter if (1) the health maintenance organization is operating significantly in contravention of its basic organizational …
AS 21.86.200 Administrative procedures.
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(a) If the director has reason to believe that grounds for the denial, suspension, or revocation of a certificate of authority exist, the director shall notify the applicant or the health maintenance organization in writing, specifically stating the grounds for denial, suspension…
AS 21.86.210 Rehabilitation, liquidation, or conservation.
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(a) A rehabilitation, liquidation, or conservation of a health maintenance organization is considered to be a rehabilitation, liquidation, or conservation of an insurer, and shall be conducted under AS 21.78. The director may apply to the superior court for an order directing the…
AS 21.86.220 Regulations.
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The commissioner of health may adopt regulations necessary to carry out the commissioner's duties under this chapter. The director may adopt regulations necessary to carry out the director's duties under this chapter.
AS 21.86.230 Fees.
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(a) A health maintenance organization shall pay fees to the director as provided under AS 21.06.250. (b) A health maintenance organization shall pay to the commissioner of health fees, as established in regulations adopted by the commissioner of health, that relate to the regulat…
AS 21.86.240 Taxation.
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A health maintenance organization is taxed as provided under AS 21.09.210(b)(1), and shall file the report required of an authorized insurer under AS 21.09.210(a).
AS 21.86.250 Penalties and enforcement.
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(a) Instead of, or in addition to, suspending or revoking a certificate of authority, the director may, in an order issued under AS 21.86.200, impose an administrative penalty in an amount not less than $1,000 nor more than $25,000 for each violation of an applicable provision of…
AS 21.86.260 Statutory construction and relationship to other law.
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(a) Except as provided in AS 21.36, AS 21.42, AS 21.54, AS 21.56, AS 21.79, and in this chapter, this title does not apply to a health maintenance organization that obtains a certificate of authority under this chapter. This subsection does not apply to an insurer licensed under …
AS 21.86.270 Filings and reports as public documents.
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Except for information described in AS 21.86.100(b)(3) and except for trade secrets, privileged, confidential commercial, or financial information as determined by the director, all applications, filings, and reports required under this chapter, including annual financial stateme…
AS 21.86.280 Confidentiality of medical information. [Repealed, § 53 ch 96 SLA 2004.]
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[Repealed or reserved.]
AS 21.86.290 Contract authority for commissioner of health.
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In carrying out duties under this chapter, the commissioner of health may contract with qualified persons to make recommendations concerning the determinations required to be made by the commissioner. Recommendations made by a contractor may be accepted in full or in part by the …
AS 21.86.300 Acquisition of control or merger of a health maintenance organization.
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(a) A person may not acquire control of the voting securities of a domestic health maintenance organization, if, after the consummation of the transaction, that person would, directly or indirectly, or by conversion or by exercise of any right to acquire, be in control of the hea…
AS 21.86.310 Dual choice.
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(a) An employer in this state, whether public or private, that offers its employees a health benefit plan and employs 25 or more employees during any week of the calendar year, and an employee benefit fund in this state that offers its members any form of health benefit, shall ma…
AS 21.86.900 Definitions.
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In this chapter, (1) “affiliation period” means a period of time under a contract with a health maintenance organization (A) that must expire before coverage becomes effective; (B) during which the health maintenance organization is not required to provide health care services or…