Title 24, Insurance

[§432D-12] Powers of insurers and hospital and medical service corporations. (a) An insurance company licensed in this State, or a hospital or medical service corporation authorized to do business in this State, either directly or through a subsidiary or affiliate, may organize a…

§432D-13 Examinations. (a) The commissioner may examine the affairs of any health maintenance organization or of any providers with whom such organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of t…

§432D-14 Suspension, revocation, or denial of certificate of authority. (a) Any certificate of authority issued under this chapter may be suspended or revoked, and any application for a certificate of authority may be denied, if the commissioner finds that any of the conditions l…

[§432D-15] Rehabilitation, liquidation, or conservation of health maintenance organizations. (a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company an…

[§432D-16] Summary orders and supervision. (a) Whenever the commissioner determines that the financial condition of any health maintenance organization is such that its continued operation might be hazardous to its enrollees, creditors, or the general public, or that it has viola…

§432D-17 Fees. (a) The commissioner shall collect, in advance, the following fees: The commissioner may, upon showing of good cause, waive or modify, in whole or part, all fees in this subsection by order. (b) No certificate of authority shall contain an expiration date, but all …

[§432D-18] Penalties and enforcement. (a) The commissioner, in lieu of suspension or revocation of a certificate of authority, may impose an administrative fine pursuant to section 432D-14(b). (b) If the commissioner, for any reason, has cause to believe that any violation of thi…

§432D-19 Statutory construction and relationship to other laws. (a) Except as provided in subsection (d) and otherwise provided in this chapter, the insurance laws and hospital or medical service corporation laws shall not apply to the activities authorized and regulated under th…

[§432D-2] Establishment of health maintenance organizations. (a) Any person may apply to the commissioner for a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. No person shall establish or operate a health maint…

[§432D-20] Filings and reports as public documents. Notwithstanding chapter 92F and any other laws to the contrary, all applications and filings required under this chapter shall be treated as public, except for trade secrets or privileged or confidential quality assurance, comme…

[§432D-21] Confidentiality of medical information. Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall no…

§432D-22 Acquisition of control of or merger of a health maintenance organization. No person may make a tender for or a request or invitation for tenders of, enter into an agreement to exchange securities for, or acquire in the open market or otherwise, any voting security of a h…

§432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in s…

§432D-23.5 Coverage for telehealth. (a) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] It is the intent of the legislature to recognize the application of telehealth as a reimbursable service by which an individual shall receive medical services from a health c…

[§432D-23.6] Federally funded programs; exemption. Requirements relating to mandated coverages shall not be applicable to any health maintenance organization offering health insurance under a federally funded program under the Social Security Act, as amended; provided that this e…

[§432D-24] Coordination of benefits. (a) Health maintenance organizations are permitted, but not required to adopt provisions for coordination of benefits to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health …

§432D-25 Disclosure of health care coverage and benefits. In order to ensure that all individuals understand their health care options and are able to make informed decisions, all health maintenance organizations shall provide current and prospective enrollees with written disclo…

[§432D-26] Genetic information nondiscrimination in health insurance coverage. (a) No health maintenance organization may: (b) As used in this section: "Family member" means, with respect to the individual, another individual related by blood to that individual. "Genetic informat…

§432D-26.3 Nondiscrimination on the basis of actual gender identity or perceived gender identity; coverage for services. (a) No health maintenance organization policy, contract, plan, or agreement shall discriminate with respect to participation and coverage under the policy, con…

§432D-27 Policies relating to domestic abuse cases. (a) No health maintenance organization shall deny or refuse to accept an application for insurance, refuse to insure, refuse to renew, cancel, restrict, or otherwise terminate a policy of insurance, or charge a different rate fo…

[§432D‑28] Federal law compliance. A health maintenance organization shall comply with applicable federal law. The commissioner shall enforce the consumer protections and market reforms relating to insurance as set forth in the federal Patient Protection and Affordable Care Act, …

[§432D-29] Prohibition on rescissions of coverage. (a) Notwithstanding sections 431:10-226.5 and 431:10A-106 to the contrary, a health maintenance organization shall not rescind coverage under a health benefit plan with respect to an individual, including a group to which the ind…

[§432D-3] Powers of health maintenance organizations. (a) The powers of a health maintenance organization include the following: (b) A health maintenance organization shall file notice, with adequate supporting information, with the commissioner prior to the exercise of any power…

[§432D-30] Medication synchronization; proration; dispensing fees. (a) Each health maintenance organization policy, contract, plan, or agreement that provides prescription drug coverage in the State shall apply a prorated daily cost-sharing rate to prescriptions that are dispense…

[§432D-31] Extension of dependent coverage. Each individual or group policy, contract, plan, or agreement and each health maintenance organization offering individual or group policies, contracts, plans, or agreements that provides dependent coverage of children shall continue to…

[§432D-32] Prohibition of preexisting condition exclusions. (a) No individual or group health maintenance organization policy, contract, plan, or agreement issued or renewed in this State shall impose any preexisting condition exclusion. (b) For purposes of this section, a "preex…

[§432D-33] Prohibited discrimination in premiums or contributions. No individual or group policy, contract, plan, or agreement and no health maintenance organization offering group or individual policies, contracts, plans, or agreements issued or renewed in this State shall requi…

[§432D-34] Services provided by participating registered pharmacists; coverage. (a) Each health maintenance organization policy, contract, plan, or agreement that is issued, amended, or renewed in the State on or after July 1, 2026, shall: (b) For the purposes of this section, "p…

[§432D-4] Fiduciary responsibilities. (a) Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of an organization shall be responsible for the funds in a fiduciary re…

§432D-5 Annual and quarterly reports. (a) Every health maintenance organization shall file annually, on or before March 1, a report verified by at least two principal officers covering the preceding calendar year. Each health maintenance organization shall file quarterly with the…

[§432D-6] Information to enrollees or subscribers. (a) The health maintenance organization shall provide to its subscribers a list of providers and participating providers, upon enrollment and reenrollment. (b) Every health maintenance organization shall provide to its subscriber…

§432D-7 Investments. All investments permitted under section 432D-3(a)(1) may be considered admitted assets in determination of net worth; provided that these investments are in compliance with article 6 of chapter 431. [L 1995, c 179, pt of §1; am L 2000, c 74, §5; am L 2003, c …

§432D-8 Protection against insolvency. (a) Net worth requirements are as follows: (b) Deposit requirements are as follows: (c) Every health maintenance organization, when determining liabilities, shall include an amount estimated in the aggregate to provide for any unearned premi…

§432D-9 Uncovered expenditures insolvency deposit. (a) If, at any time, uncovered expenditures exceed ten per cent of total health care expenditures, a health maintenance organization shall place with the commissioner or with any organization or trustee acceptable to the commissi…

[§432D-9.5] Reserve credit for reinsurance. Any health maintenance organization that takes credit for reserves on risks ceded to a reinsurer shall be subject to provisions of chapter 431 related to credit for reinsurance. [L 2000, c 74, §2]