Title 21 — Insurance
53 chapters · 1,244 sections in this title.
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…
AS 21.87.010 Applicability.
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(a) This chapter applies to every individual, person, firm, corporation, association, or organization of any kind hereafter engaging or purporting to engage in the provision of all or part of a health care service as defined in AS 21.87.330, for its subscribers in exchange for pe…
AS 21.87.020 Purpose and interpretation.
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(a) It is the purpose of this chapter to regulate in the public interest the formation and operation of prepaid health care service organizations, in order that the services may be made available upon a basis of fair and equitable contracts through state-licensed nonprofit organi…
AS 21.87.030 Provisions exclusive.
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A provision of this title does not apply to a health care service corporation unless contained or referred to in this chapter.
AS 21.87.040 Incorporation and certificate of authority required.
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A person otherwise subject to this chapter may not engage or purport to engage in the provision of any part or all of a health care service for its subscribers in exchange for periodic prepayments in identifiable amount unless it is a service corporation incorporated under the la…
AS 21.87.050 Incorporation, approval of articles and amendments.
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(a) A service corporation shall be formed as a nonprofit, nonstock medical service corporation, or hospital service corporation, or a combination medical and hospital service corporation, consistent with the applicable requirements of this chapter under the statutes of this state…
AS 21.87.060 Name of corporation.
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A service corporation may not have or use a corporate or business name that includes the words “insurance,” “casualty,” “surety,” “health and accident,” “mutual,” or other terms descriptive of an insurer or insurance business. A service corporation may not have or use a name so s…
AS 21.87.070 Qualifications for certificate of authority.
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[Repealed or reserved.]
AS 21.87.080 Application for certificate of authority.
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(a) Application for a certificate of authority to transact business as a service corporation shall be made to the director, on forms as prepared and furnished by the director and requiring the information relative to the applicant, its directors, officers, and affairs as the dire…
AS 21.87.090 Issuance or refusal of certificate of authority.
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(a) If, after the application for certificate of authority is completed, the director finds that the applicant is fully qualified for a certificate of authority in accordance with this chapter, and that the service agreements, subscribers contracts, schedule of rates are in compl…
AS 21.87.100 Continuance or expiration of certificate of authority.
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(a) A certificate of authority issued to a service corporation shall continue in force as long as the corporation is entitled to it under this chapter, and until suspended or revoked by the director or terminated at the request of the corporation; subject, however, to continuance…
AS 21.87.110 Suspension or revocation of certificate of authority.
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(a) The director shall suspend or revoke the certificate of authority of a service corporation that the director finds, after a hearing, is no longer qualified under this chapter. (b) The director may after a hearing, suspend or revoke the certificate of authority for a violation…
AS 21.87.120 Services and benefits that may be provided by medical service corporations.
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(a) A medical service corporation shall have the right to provide to its subscribers part or all of the following services and benefits only: (1) medical and surgical services furnished to the subscriber by participant providers; (2) indemnity in reasonable amount with respect to…
AS 21.87.130 Services and benefits that may be provided by hospital service corporations.
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(a) A hospital service corporation shall have the right to provide to its subscribers part or all of the following services and benefits only: (1) hospital services furnished to the subscriber by participant hospitals; (2) indemnity in a reasonable amount with respect to hospital…
AS 21.87.140 Medical service agreements.
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(a) A medical service corporation shall enter into service agreements with providers licensed by the state only. (b) Each service agreement shall require the participant providers to furnish to subscribers of the service corporation the medical or surgical services, or both, that…
AS 21.87.150 Hospital service agreements.
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(a) A hospital service corporation shall enter into service agreements with hospitals approved or licensed by the state only. (b) Each service agreement must require the participant hospital to furnish to subscribers of the service corporation the hospital services that are, unde…
AS 21.87.160 Subscriber's contracts.
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(a) Each subscriber's contract issued after July 1, 1966, by a service corporation constitutes a direct obligation of the participant providers or participant hospitals of the service corporation to render the medical or hospital services, as the case may be, as agreed to be rend…
AS 21.87.170 Minimum service benefits.
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(a) Each service agreement and subscriber's contract entered into or issued by a service corporation must provide for health care services of a substantial and broad character to be rendered to subscribers on a service basis by participant providers or participant hospitals. (b) …
AS 21.87.180 Filing and approval of agreements and contracts.
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(a) A service corporation may not issue or use a basic form of service agreement or subscriber's contract, or application, identification, supplement, or endorsement to be connected with the agreement or contract, until the form has been filed with and approved by the director. T…
AS 21.87.190 Charges and rates; rating methods.
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(a) Subscription rates, fees, and payments to be charged by a service corporation to or on account of its subscribers may not be excessive, inadequate, or unfairly discriminatory; and rates of payments to be made to participant providers and participant hospitals for services ren…
AS 21.87.200 Reserves.
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In addition to the surplus fund provided for in AS 21.87.210, each service corporation shall establish and maintain unimpaired reserves and liabilities required under AS 21.18.050.
AS 21.87.210 Surplus fund.
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(a) Each service corporation shall set aside into a “surplus fund” an amount of money equal to not less than two percent of all sums hereafter received by it on account of subscriber's contracts, until the surplus fund amounts to not less than $50,000 if a medical service corpora…
AS 21.87.220 Investments.
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(a) A service corporation shall invest and have invested its funds in the following investments only: (1) cash on deposit or in savings accounts in banks or trust companies in this state; (2) deposits in or shares of the savings and loan associations that are insured by an instru…
AS 21.87.230 Records and accounts.
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(a) Every service corporation shall establish and maintain complete and accurate records and accounts covering its transactions and affairs, in accordance with common and accepted principles and practices of insurance accounting and record keeping as applied to the business of th…
AS 21.87.240 Annual statement and fees.
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(a) Each service corporation shall annually before March 2 file with the director a statement of its financial condition as at the preceding December 31. The statement must be in the form, and provide for the information relative to the corporation's affairs, that the director pr…
AS 21.87.250 Examination.
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Every service corporation shall be subject to examination by the director, with the same rights and powers and in the same manner as is provided in this title for the examination of insurers; and for the purposes thereof AS 21.06.120 — 21.06.180 shall, to the extent applicable, a…
AS 21.87.260 Taxation.
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Every hospital and medical service corporation doing business under this chapter shall be taxed as provided in AS 21.09.210.
AS 21.87.270 Joint operations.
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(a) A hospital service corporation and a medical service corporation may operate under joint management for the purpose of reducing operating costs. (b) Separate records and accounts shall be kept for each corporation, and the funds and assets of one may not be commingled with th…
AS 21.87.280 Combined corporation.
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(a) A service corporation may be formed as, or may by suitable amendment of its articles of incorporation become, a combined medical service and hospital service corporation. As to its medical services each combined service corporation shall fully comply with those provisions of …
AS 21.87.290 Contracts covering workers' compensation risks.
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A service corporation may not issue a subscriber's contract covering, or otherwise insure, an industrial injury or illness if health care service or indemnity benefits are provided by either federal or state law, or under the Alaska Workers' Compensation Act.