Title 21 — Insurance
53 chapters · 1,244 sections in this title.
AS 21.84.460 Suspension and revocation of license. [Repealed, § 223 ch 67 SLA 1992.]
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[Repealed or reserved.]
AS 21.84.465 Reports.
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(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…
AS 21.84.470 Misrepresentation. [Repealed, § 36 ch 96 SLA 1997.]
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[Repealed or reserved.]
AS 21.84.475 License.
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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…
AS 21.84.480 Discrimination and rebates. [Repealed, § 36 ch 96 SLA 1997.]
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[Repealed or reserved.]
AS 21.84.485 Examination of societies.
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[Repealed or reserved.]
AS 21.84.490 Service of process. [Repealed, § 36 ch 96 SLA 1997.]
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[Repealed or reserved.]
AS 21.84.495 Foreign or alien society; admission.
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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…
AS 21.84.500 Secs. 21.84.500 — 21.84.520. Consolidations and mergers; effect of consolidations and mergers; conversion into mutual life insurer. [Repealed, § 36 ch 96 SLA 1997.]
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[Repealed or reserved.]
AS 21.84.530 Injunction, liquidation, receivership of domestic society.
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(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)…
AS 21.84.535 Suspension, revocation, or refusal of license of foreign or alien society.
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(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…
AS 21.84.540 Injunction.
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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.
AS 21.84.550 Review. [Repealed, § 36 ch 96 SLA 1997.]
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[Repealed or reserved.]
AS 21.84.560 Society and fraternal benefit societies defined. [Repealed, § 223 ch 67 SLA 1992.]
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[Repealed or reserved.]
AS 21.84.565 Licensing of agents.
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(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…
AS 21.84.570 Lodge system defined. [Repealed, § 223 ch 67 SLA 1992.]
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[Repealed or reserved.]
AS 21.84.575 Unfair methods of competition and unfair and deceptive acts and practices.
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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…
AS 21.84.580 Representative form of government defined. [Repealed, § 223 ch 67 SLA 1992.]
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[Repealed or reserved.]
AS 21.84.590 Other provisions applicable. [Repealed, § 36 ch 96 SLA 1997.]
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Article 7. Miscellaneous.
AS 21.84.625 Service of process.
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(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…
AS 21.84.650 Penalties.
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(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 …
AS 21.84.675 Review.
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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.
AS 21.84.700 Exemption of certain societies.
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(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…
AS 21.84.900 Definitions.
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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…
AS 21.85.010 Certificate of authority required.
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(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…
AS 21.85.020 Name.
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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…
AS 21.85.030 Qualifications for a certificate of authority.
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(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…
AS 21.85.040 Application for a certificate of authority.
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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…
AS 21.85.050 Minimum reserves.
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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.
AS 21.85.060 Investments.
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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…
AS 21.85.070 Contribution rates.
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(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…
AS 21.85.080 Reporting requirements.
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(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…
AS 21.85.090 Consumer information notice.
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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 …
AS 21.85.100 Applicability of other provisions.
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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…
AS 21.85.500 Definitions.
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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…
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…