Title 24, Insurance

§432:2-607 Suspension, revocation or refusal of license of foreign or alien society. (a) When the commissioner upon investigation finds that a foreign or alien society transacting or applying to transact business in this State: the commissioner shall notify the society of such de…

§432:2-608 Injunction. No application or petition for injunction against any domestic, foreign or alien society, or lodge, shall be recognized in any court of the State unless made by the attorney general upon request of the commissioner. [L 1987, c 347, pt of §2]

§432:2-609 Licensing of producers. (a) Fraternal benefit society producers shall be licensed in accordance with the provisions governing producers in articles 7 and 9A of chapter 431, except that the appointment shall be made by the fraternal benefit society. Fraternal benefit so…

§432:2-610 Unfair methods of competition and unfair and deceptive acts and practices. Every society authorized to do business in this State shall be subject to the provisions of article 13 of the insurance code relating to unfair practices; provided, however, that nothing in such…

[§432:2‑611] Federal law compliance. A fraternal benefit society 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, Publ…

PART VII. MISCELLANEOUS §432:2-701 Service of process. (a) Every society authorized to do business in this State shall appoint in writing the commissioner and each successor in office to be its true and lawful attorney upon whom all lawful process in any action or proceeding agai…

§432:2-702 Review. All decisions and findings of the commissioner made under the provisions of this article shall be subject to review by proper proceedings in any court of competent jurisdiction in this State. [L 1987, c 347, pt of §2]

§432:2-703 Penalties. (a) Any person who wilfully makes a false or fraudulent statement in or relating to an application for membership or for the purpose of obtaining money from or a benefit in any society, shall upon conviction be fined not less than $100 nor more than $500 or …

§432:2-704 Exemption of certain societies. (a) Nothing contained in this article shall be so construed as to affect or apply to: (b) Any such society or association described in subsections (a)(3) or (4) which provides for death or disability benefits for which benefit certificat…

§432:2-705 Severability. If any provision of this article or the application of such provision to any circumstance is held invalid, the remainder of the article or the application of the provision to other circumstances, shall not be affected thereby. [L 1987, c 347, pt of §2]

§432C-1 Definitions. As used in this chapter: "Commissioner" means the insurance commissioner. "Conversion" means the transfer or sale of a significant amount of a nonprofit entity's assets to a for-profit entity or through any other means as determined by the commissioner. The d…

[§432C-2] Application for conversion. (a) A nonprofit entity shall file an application with the commissioner at least six months prior to a proposed conversion. The application shall include a report of the activities of the nonprofit entity and a plan for the conversion includin…

[§432C-3] Approval process. (a) No nonprofit entity may engage in a conversion without prior approval of the application for conversion by the commissioner. Any conversion without the commissioner's approval shall be voidable by the commissioner. (b) Prior to approval of the conv…

[§432C-4] Directors, officers of nonprofit entity; prohibition. (a) Directors or officers of a nonprofit entity are prohibited from directly benefiting from the conversion. (b) No officer of the nonprofit entity who is employed by the nonprofit entity at the time the conversion a…

[§432C-5] Transfer of assets to other nonprofit entities. The commissioner shall determine prior to any conversion, the nonprofit entities, if any, that are eligible to receive assets from the converting nonprofit entity. The charitable mission and grant-making functions of each …

[§432C-6] For-profit entity; after conversion. After conversion, the for-profit entity shall not be subject to this chapter, but if a stock insurance company, shall be in conformance with title 24. [L 1998, c 260, pt of §2]

[§432C-7] Judicial review. Any final order or action by the commissioner may be subject to judicial review by the circuit court. [L 1998, c 260, pt of §2]

§432D-1 Definitions. For purposes of this chapter: "Basic health care services" means the following medical services: preventive care, emergency care, inpatient and outpatient hospital and physician care, diagnostic laboratory services, and diagnostic and therapeutic radiological…

[§432D-1.5] Bona fide trade associations. (a) At the option of a bona fide trade association, or its designated agent, a health maintenance organization that sells health insurance to the bona fide trade association shall treat the bona fide trade association and its members as a…

[§432D-10] Enrollment period. (a) In the event of an insolvency of a health maintenance organization, upon order of the commissioner, all other carriers offered as alternatives to the insolvent health maintenance organization at a group's last regular enrollment period shall offe…

[§432D-11] Replacement coverage. (a) For purposes of this chapter, "discontinuance" means the termination of the contract between the group contract holder and a health maintenance organization due to the insolvency of the health maintenance organization, and does not refer to th…

[§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…