Title 58 — INSURANCE

Each application for a certificate of authority shall include financial statements showing the applicant's assets, liabilities, and sources of financial support. If the applicant's financial affairs are audited by independent certified public accountants, a copy of the applicant'…

A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure which the provider who furnished such information to the health maintenance organization is entitled to claim. Source: SL 1974, ch 321 , § 36 (5).

Any data or information pertaining to the diagnosis, treatment, or health of any enrollee, or any application obtained from any person, shall be confidential and shall not be disclosed to any person except: (1) To the extent that it may be necessary to carry out the purposes of t…

58-41-79 Hearing on cease and desist order--Procedure--Judicial review. 58-41-80 Injunctive relief against violations--Venue. 58-41-81 Suspension or revocation of certificate of authority on findings by director. 58-41-82 Additional grounds for suspension or revocation. 58-41-83 …

The director may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of the provision of this chapter. Source: SL 1974, ch 321 , § 47.

Within twenty days after service of the order to cease and desist, the respondent may request a hearing on the question of whether acts or practices in violation of this chapter have occurred. Such hearings shall be conducted pursuant to, and judicial review shall be available as…

Each application for a certificate of authority shall include: (1) A copy of the form of each evidence of coverage to be issued to the enrollees; (2) A copy of the form of each individual or group health maintenance contract which is to be issued to enrollees or their representat…

In the event of any violation of the provisions of this chapter, if the director elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order pursuant to § 58-41-79 , the director may institute a proceeding to obtain injunctive reli…

The director may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if the director finds that any of the following conditions exists: (1) The health maintenance organization is operating significantly in contravention of…

The director may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if: (1) The health maintenance organization does not meet the requirements of § 58-41-12 ; or (2) The health maintenance organization is unable to fulfil…

If the director, for any reason, has cause to believe that any violation of this chapter has occurred or is threatened, the director may, before commencing action under § 58-41-81 , 58-41-82 , 58-41-85 , or 58-41-87 , give notice to the health maintenance organization and to the …

Proceedings under § 58-41-83 are not governed by any formal procedural requirements, and may be conducted in such manner as the director finds appropriate under the circumstances. Source: SL 1974, ch 321 , § 46; SL 2013, ch 256 , § 30.

The director may, in lieu of suspension or revocation of a certificate of authority under 58-41-81 or 58-41-82 , levy a money penalty pursuant to §

A certificate of authority shall be suspended or revoked only after compliance with the requirements of §§ 58-41-87 to 58-41-91 , inclusive. Source: SL 1974, ch 321 , § 37.

The director of the Division of Insurance may, without advance notice or a hearing thereon, immediately suspend the certificate of authority of a health maintenance organization as to which proceedings for receivership, conservatorship, rehabilitation, or other delinquency procee…

If the director has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, the director shall notify the health maintenance organization in writing …

The provisions of chapter 1-26 , including the right of judicial review, apply to proceedings under §§ 58-41-85 to 58-41-91 , inclusive, to the extent those provisions are not in conflict with other provisions of such sections. Source: SL 1974, ch 321 , § 39 (4); SL 2000, ch 235 …

58-41-90 Action of director after hearing--Written findings. 58-41-91 Judicial review. 58-41-92 Activities prohibited during suspension of certificate. 58-41-93 Winding up after revocation of certificate--Continued operation to protect enrollees. 58-41-94 Summary proceeding to re…

Each application for a certificate of authority shall include a description of the proposed method of marketing the plan, a schedule of proposed charges, and a financial plan which includes a three - year projection of the expenses and income and other sources of future capital. …

After hearing pursuant to §§ 58-41-87 and 58-41-88 , or upon the failure of the health maintenance organization to appear at such hearing, the director shall take action as is deemed advisable on written findings which shall be mailed to the health maintenance organization. Sourc…

The action of the director is subject to the court of primary jurisdiction for claims of the nature and magnitude described. The court may, in disposing of the issue before it, modify, affirm, or reverse the order of the director in whole or in part. Source: SL 1974, ch 321 , § 3…

When the certificate of authority of a health maintenance organization is suspended, the health maintenance organization may not, during the period of such suspension, enroll any additional enrollees except newborn children or other newly acquired dependents of existing enrollees…

When the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs, and shall conduct no further business except as may be essential to the …

The director may apply for an order directing him to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more of the grounds set out in chapter 58-29B , or when in his opinion the continued operation of the health maintenance organization would …

Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the director pursuant to chapter 58-29B , except to…

If a part of this chapter is invalid, all valid parts that are severable from the invalid part remain in effect. If a part of this chapter is invalid in one or more of its applications, the part remains in effect in all valid applications that are severable from the invalid appli…

This chapter may be cited as the "Health Maintenance Organization Act of 1974." Source: SL 1974, ch 321 , § 1.

Every health maintenance contract that is delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall offer coverage for testing, diagnosis, and treatment of phenylketonuria inc…

Notwithstanding the provisions of chapter 47-34A and §§ 47-15-2 and 47-22-4 , any organization may form for the purposes of purchasing group health insurance on a voluntary basis. For purposes of §§ 58-41-99 to 58-41-109 , inclusive, an organization means any nonprofit organizati…