Title 83, Insurance

Whenever any policy of insurance or any medical service plan or hospital service contract or hospital and medical service contract issued in this state provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed dentist, as defined b…

Whenever any policy of insurance or any medical service plan or hospital service contract or hospital and medical service contract issued in this state provides for reimbursement for any diagnosis and treatment of mental, nervous or emotional disorders only which are within the l…

From and after January 1, 1999, whenever any policy of insurance or any medical service plan or hospital service contract or hospital and medical service contract issued, delivered, administered, continued or renewed in this state provides for reimbursement for any service which …

A policy or contract providing for third-party payment or prepayment of health or medical expenses shall include a provision for the payment of necessary medical or surgical care and treatment provided by a duly certified nurse practitioner and performed within the scope of the l…

Whenever any policy of insurance or any medical service plan or hospital service contract or hospital and medical service contract issued in this state provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed chiropractor as defin…

Any health care service plan contract that provides hospital, outpatient, medical or surgical coverage that is issued, amended, delivered or renewed in this state shall include obstetricians/gynecologists as primary care physicians and allow direct access to obstetricians/gynecol…

(1) If any health insurance issuer or other health insurance benefit payer limits the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer or other health insurance benefit payer shall have the same time limit…

This article may be cited as the Health Maintenance Organization, Preferred Provider Organization and Other Prepaid Health Benefit Plans Protection Act.

(a) “Basic health care services” means the following medically necessary services: preventive care, emergency care, inpatient and outpatient hospital and physician care, diagnostic laboratory and diagnostic and therapeutic radiological services and includes but is not limited to …

(1) Notwithstanding any law of this state to the contrary, any person may apply to the commissioner for a certificate of authority to establish and operate a health maintenance organization in compliance with this article. No person shall establish or operate a health maintenance…

(1) (a) Upon receipt of an application for issuance of a certificate of authority, the commissioner shall forthwith transmit copies of the application and accompanying documents to the State Health Officer.(b) The State Health Officer shall determine whether the applicant for a c…

(1) The powers of a health maintenance organization include, but are not limited to, the following:(a) The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and any property as may reasona…

(1) Any director, officer, employee, contractor or partner of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of such organization shall be responsible for the funds in a fiduciary relationship to the organiza…

(1) The health maintenance organization shall establish procedures to assure that the health care services provided to enrollees shall be rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice. The…

(1) (a) Every group and individual contract holder is entitled to a group or individual written contract respectively.(b) The contract shall not contain provisions or statements which are unjust, unfair, inequitable, misleading, deceptive, or which encourage misrepresentation as …

(1) Every health maintenance organization shall annually, on or before the first day of March, file a report verified by at least two (2) principal officers with the commissioner, with a copy to the State Health Officer, covering the preceding calendar year. Such report shall be …

(1) The health maintenance organization shall provide to its subscribers a list of providers, upon enrollment, re-enrollment or at a minimum annually. (2) Every health maintenance organization shall provide within thirty (30) days to its subscribers notice of any material change …

(1) Every health maintenance organization shall establish and maintain a grievance procedure which has been approved by the commissioner, after consultation with the State Health Officer, to provide procedures for the resolution of grievances initiated by enrollees. The health ma…

With the exception of investments made in accordance with Section 83-41-309(1)(a), the funds of a health maintenance organization shall be invested only in accordance with investment permitted by the laws of the State of Mississippi for life insurance companies (Section 83-19-51 …

(1) Before issuing any certificate of authority, the commissioner shall require that the health maintenance organization have an initial net worth of One Million Five Hundred Thousand Dollars ($1,500,000.00) and shall thereafter maintain the minimum net worth required under subse…

(1) If at any time uncovered expenditures exceed ten percent (10%) of total health care expenditures, a health maintenance organization shall place an uncovered expenditures insolvency deposit with the commissioner, with any organization or trustee acceptable to the commissioner …

(1) In the event of an insolvency of a health maintenance organization, upon order of the commissioner all other carriers that participated in the enrollment process with the insolvent health maintenance organization at a group’s last regular enrollment period shall offer such gr…

(1) No premium rate may be used until either a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the commissioner. (2) Either a specific schedule of premium rates, or a methodology for determining premium rates, shall be es…

(1) The commissioner may, after notice and hearing, promulgate rules and regulations as are necessary to provide for the licensing of health maintenance organization producers. The rules shall establish:(a) The requirements for licensure of resident health maintenance organizatio…

(1) An insurance company 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 arti…

(1) The commissioner shall make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements or other arrangements as often as is reasonably necessary for the protection of the interests of the people of …

(1) Any certificate of authority issued under this article may be suspended or revoked, and any application for a certificate of authority may be denied, if the commissioner after a hearing finds that any of the conditions listed below exist:(a) The health maintenance organizatio…

(1) Any rehabilitation, liquidation or administrative supervision of a health maintenance organization shall be deemed to be the same as the rehabilitation, liquidation or administrative supervision of an insurance company and shall be conducted under the supervision of the commi…

(1) 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 violated any provision of this article, he may, …

The commissioner may, after notice and hearing, promulgate reasonable rules and regulations, as are necessary or proper to carry out the provisions of this article.

(1) Every health maintenance organization subject to this article shall pay to the commissioner the following fees:(a) For filing an application for a certificate of authority for a health maintenance organization and amendment thereto$5,000.00;(b) For filing an amendment to the …

(1) The commissioner may, in lieu of suspension or revocation of a certificate of authority under Section 83-41-339, levy an administrative penalty in an amount not less than One Hundred Dollars ($100.00) per violation, nor more than One Thousand Dollars ($1,000.00) per violation…

(1) This provision shall not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance law or the hospital or medical service corporation laws of this state except with respect to its health maintenance organization activities…

All applications, filings and reports required under this article shall be treated as public documents, except those which are trade secrets or privileged or confidential quality assurance, commercial or financial information, other than any annual financial statement that may be…

(1) Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from the person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent…

The State Health Officer in carrying out his obligations under this article, may contract with qualified persons to make recommendations concerning the determinations required to be made by him. The recommendations may be accepted in full or in part by the State Health Officer.

No person may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the co…

(1) Health maintenance organizations are permitted, but not required, to adopt coordination of benefits provisions to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two (2) or more group health insurance or health care plans. (2) …

(1) When a health maintenance organization in this state is declared insolvent by a court of competent jurisdiction, the commissioner may levy an assessment on health maintenance organizations doing business in this state to pay claims for uncovered expenditures for enrollees who…

The commissioner may contract with the necessary personnel to carry out the duties and responsibilities created by this article and make assessments for the expenses incurred in carrying out the duties and responsibilities of this article.

This article shall be known and may be cited as the “Patient Protection Act of 1995.”

(a) As used in this article:(a) “Department” means the Mississippi Department of Insurance.(b) “Managed care plan” means a plan operated by a managed care entity as described in paragraph (c) of this section that provides for the financing and delivery of health care services to …

The department shall establish a process for the certification of managed care plans offered or provided to persons residing in Mississippi. No such plan shall be offered or provided to persons residing in this state unless it has been certified by the department. Any managed car…

The department shall establish a fee to cover the costs of issuing and renewing the certifications authorized by this article and the fees shall be used solely for the administration of this article.

(a) In order to be certified and recertified under this article, a managed care plan shall:(a) Provide enrollees or other applicants with written information on the terms and conditions of coverage in easily understandable language including, but not limited to, information on th…

Health maintenance organizations must comply with the certification requirements in this article in addition to such other laws as might relate thereto.