Title 21, Insurance

(a) Standards of valuation for certificates issued before January 1, 1999 shall be those provided by the laws applicable immediately before January 1, 1998. (b) The minimum standards of valuation for certificates issued on or after January 1, 1999 shall be based on the following …

[Repealed or reserved.]

(a) Reports shall be filed in accordance with the provisions of this section. (b) A society transacting business in this state shall annually, before March 2, unless the time has been extended by the director for cause shown, file with the director a true statement of the society…

[Repealed or reserved.]

Societies that are authorized to transact business in this state on January 1, 1998, and societies licensed after January 1, 1998 and before July 1, 1998, may continue the business through June 30, 1998. The authority of those societies and all other societies licensed after Janu…

[Repealed or reserved.]

The director may examine a society in the manner authorized for an insurer under AS 21.06.120 — 21.06.230. The requirements, procedures, authorization, and process for examinations authorized under this section shall be the same as for an insurer.

[Repealed or reserved.]

A foreign or alien society may not transact business in this state without a license issued by the director. A foreign or alien society desiring admission to this state shall comply with the requirements and limitations of this chapter applicable to domestic societies. The societ…

[Repealed or reserved.]

(a) When the director upon investigation finds that a domestic society (1) has exceeded its powers; (2) has failed to comply with this chapter; (3) is not fulfilling its contracts in good faith; (4) has a membership of fewer than 400 after an existence of one year or more; or (5)…

(a) When the director, upon investigation, finds that a foreign or alien society transacting or applying to transact business in this state (1) has exceeded its powers, (2) has failed to comply with a provision of this chapter, (3) is not fulfilling its contracts in good faith, o…

An application or petition for injunction against a domestic, foreign, or alien society, or branch thereof, may not be recognized in a court of this state unless made by the attorney general upon request of the director.

[Repealed or reserved.]

[Repealed or reserved.]

(a) Agents of societies shall be licensed in accordance with the provisions of AS 21.27. (b) An examination or license may not be required of a regular salaried officer, employee, or member of a licensed society who devotes substantially all the person's services to activities ot…

[Repealed or reserved.]

A society and an agent authorized to do business in this state are subject to the provisions of AS 21.36; however, nothing in those provisions shall be construed as applying to or affecting (1) the right of a society to determine its eligibility requirements for membership; or (2…

[Repealed or reserved.]

Article 7. Miscellaneous.

(a) A society authorized to do business in this state shall appoint in writing the director and the director's successors in office to be its true and lawful attorney upon whom all lawful process in an action or proceeding against it shall be served. The society shall agree in wr…

(a) A person who knowingly makes a false or fraudulent statement or representation in or with reference to an application for membership, or for the purpose of obtaining money from or a benefit in a society, is guilty of a misdemeanor and is punishable by a fine of not more than …

Decisions and findings of the director made under the provisions of this chapter are subject to review by proceedings in a court of competent jurisdiction in this state.

(a) Nothing contained in this chapter shall be construed to affect or apply to (1) grand or subordinate lodges of societies, orders, or associations doing business in this state that provide benefits exclusively through local or subordinate lodges; (2) societies, orders, or assoc…

In this chapter, (1) “alien society” means a society formed under the laws other than those of the United States of America, its states, territories, or the District of Columbia; (2) “benefit contract” means the agreement for provision of benefits authorized by AS 21.84.201, as t…

(a) A person may not establish or maintain a self-funded multiple employer welfare arrangement except as authorized by a subsisting certificate of authority issued to the arrangement by the director. (b) A self-funded multiple employer welfare arrangement is established or mainta…

A self-funded multiple employer welfare arrangement may not use a name that includes the words “insurance,” “casualty,” “surety,” “health and accident,” “mutual,” or other terms descriptive of an insurer or insurance business. A self-funded multiple employer welfare arrangement m…

(a) The director may not issue a certificate of authority to a self-funded multiple employer welfare arrangement unless the arrangement establishes to the satisfaction of the director that (1) employers participating in the arrangement are members of a bona fide association or gr…

To apply for an original certificate of authority, a self-funded multiple employer welfare arrangement shall file with the director its application, accompanied by the applicable fees set under AS 21.06.250, showing its name, the location of its home office, its date of organizat…

A self-funded multiple employer welfare arrangement shall establish and maintain reserves equal to the greater of (1) 30 percent of the unpaid claim liability of the arrangement; or (2) the amount recommended and certified by a qualified actuary.

A multiple employer welfare arrangement shall maintain an amount at least equal to 85 percent of net unpaid claim liability in (1) cash and cash equivalents; (2) the fully insured portion of a bank deposit when the insurance is provided by a solvent agency of the United States go…

(a) A self-funded multiple employer welfare arrangement shall establish and maintain contribution rates that (1) fund the greater of (A) the amount recommended and certified by a qualified actuary in order for the self-funded multiple employer welfare arrangement to remain financ…

(a) A self-funded multiple employer welfare arrangement shall annually, before March 2, file with the director on forms prescribed by the director, a full and true statement of its financial condition, transactions, and affairs as of the preceding December 31, including (1) a sta…

A self-funded multiple employer welfare arrangement must provide a written notice to each participating employee at the time that coverage becomes effective. The notice must (1) be clear and conspicuous; (2) be in at least 10-point type; (3) state that (A) the coverage is issued …

In addition to the provisions contained or referred to in this chapter, the following chapters and provisions of this title also apply with respect to self-funded multiple employer welfare arrangements to the extent applicable and not in conflict with the express provisions of th…

In this chapter, (1) “allowable benefit” means a benefit for medical care; (2) “bona fide association” has the meaning given in AS 21.54.500; (3) “claims liability” means the total of all incurred and unpaid claims for allowable benefits under a self-funded multiple employer welf…

(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…

(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…

(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…

(a) The governing body of a health maintenance organization may include providers, or other individuals, or both. At least one-quarter of the governing body must consist of consumers who are substantially representative of enrollees. (b) The governing body of a health maintenance…

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 …

(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…

(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…

(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…

(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…