Title 31A, Title 31A: Insurance Code

31A-8-105. General powers of organizations. (1) Except as provided in Subsection, an organization may: (2) buy, sell, lease, encumber, construct, renovate, operate, or maintain hospitals, health care clinics, other health care facilities, and other real and personal property inci…

31A-8-105.5. Primary care physicians. With regard to participating providers who are physicians who are members of the American College of Obstetrics and Gynecology, organizations operating under this chapter shall: (1) permit a female enrollee to receive at least one outpatient …

31A-8-106. Other business. No organization may engage, directly or indirectly, in any business other than that of an organization and business reasonably incidental to that business.

31A-8-107. Documents as evidence. Sectionapplies to documents as evidence in organizations.

31A-8-108. Unauthorized assumption of corporate power. Sectionapplies to the unauthorized assumption of corporate power in organizations.

31A-8-201. Scope of part. This part applies to all organizations doing business in this state.

31A-8-202. Corporate name -- Office -- Registered agent. (1) Sections,, andapply to the reservation and registration of the corporate name in domestic health maintenance organizations. 16-1a-304 16-10a-403 42-2-201 Reservation and registration fees under Sectionapply. 31A-3-103 (…

31A-8-202. Corporate name -- Office -- Registered agent. (1) Sections,, andapply to the reservation and registration of the corporate name in domestic health maintenance organizations. Reservation and registration fees under Sectionapply. 16-10a-402 16-10a-403 42-2-5 31A-3-103 (2…

31A-8-203. Incorporators. One or more adult natural persons may organize and act as the incorporators of a domestic health maintenance organization under this part.

31A-8-204. Articles and bylaws. (1) The articles of a nonprofit organization shall conform to Subsectionsthrough. The articles of other organizations shall conform to Section. In addition: 16-6a-202(1)(a) (e) 16-10a-202 the powers of the corporation shall be limited to those perm…

31A-8-205. Organization permit and certificate of incorporation. (1) Sectionapplies to the formation of organizations, except that "Section" in Subsectionshall be read "Section." 31A-5-204 31A-5-211 31A-5-204(5) 31A-8-209 (2) In addition to the requirements of Section, the applic…

31A-8-206. Powers under organization permit -- Deposit of proceeds of subscriptions. Sectionsandapply to the powers of an organization under an organization permit and the deposit of proceeds of subscriptions, except that there are no qualifying insurance policies as referred to …

31A-8-207. Termination of organization permit -- Payment of organization expenses. Section, other than Subsection, applies to the termination of the organization permit and the payment of organization expenses of organizations, except that "Section" shall be read "Section."

31A-8-208. Incorporators' liability and organization expenses. Sectionapplies to incorporators' liability and organization expenses in organizations.

31A-8-209. Minimum capital or minimum permanent surplus. (1) A health maintenance organization being organized or operating under this chapter shall have and maintain a minimum capital or minimum permanent surplus of $100,000. Each health maintenance organization authorized to do…

31A-8-211. Deposit. (1) Except as provided in Subsection, each health maintenance organization authorized in this state shall maintain a deposit with the commissioner under Sectionin an amount equal to the sum of: (2) 31A-2-206 $100,000; and 50% of the greater of: $900,000; 2% of…

31A-8-213. Certificate of authority. (1) An organization may apply for a certificate of authority at any time prior to the expiration of its organization permit. The application shall include: a detailed statement by a principal officer about any material changes that have taken …

31A-8-214. Securities. , applies to securities of organizations, except that the amount "$150,000" in Subsectionshall be read "one-half of the minimum capital required of the organization."

31A-8-215. Management. , applies to organizations, except that for purposes of this chapter, Subsectionsthroughshall be read: "corporate reorganizations under Section."

31A-8-216. Corporate reorganizations. Sectionsthroughand Sectionapply to corporate reorganizations of organizations.

31A-8-217. Material transactions by insurers which are part of holding company system. (1) This section applies to an insurer licensed under this chapter that is part of a holding company system, for purposes of: the reporting requirements of Section; and 31A-16-105 the material …

31A-8-301. Requirements for doing business in state. (1) Only a corporation incorporated and licensed under, may do business in this state as an organization. Part 2, Domestic Organizations (2) To do business in this state as an organization, a foreign corporation doing a similar…

31A-8-303. Foreign ambulance membership organizations. A foreign ambulance membership organization limited health plan is exempt from: (1) Section; 31A-8-204 (2) Section; 31A-8-205 (3) Section; 31A-8-206 (4) Section; 31A-8-211 (5) Section; 31A-8-214 (6) Section; 31A-8-215 (7) Sec…

31A-8-401. Enrollee participation. Every organization shall provide a reasonable procedure, consistent with Section, for allowing enrollees to participate in matters of policy of the organization and for resolving complaints and adverse benefit determinations initiated by enrolle…

31A-8-403. Examination of organization and providers. Examinations of a health maintenance organization and its providers shall be conducted according to the provisions of. Except during an audit of the internal quality control system, medical records of individual patients kept …

31A-8-404. Annual audit of internal quality control. (1) Each organization shall prepare an annual report of the effectiveness of the organization's internal quality control. (2) The annual report shall be: in a form the commissioner approves; and certified and signed by two offi…

31A-8-405. Confidentiality of medical records and audits. Unless a court orders otherwise, the department shall treat the following records and information as confidential and prevent their disclosure to the public: (1) the medical records of enrollees of an organization; and (2)…

31A-8-406. Distribution by nonprofit organizations. A nonprofit organization may pay compensation in a reasonable amount to its members, trustees, or officers for services rendered, may make reasonable incentive payments to its providers, may confer benefits upon its members in c…

31A-8-407. Written contracts -- Limited liability of enrollee -- Provider claim disputes -- Leased networks. (1) Every contract between an organization and a participating provider of health care services shall be in writing and shall set forth that if the organization: fails to …

31A-8-408. Organizations offering point of service or point of sales products. Effective July 1, 1991, a health maintenance organization offering products that permit members the option of obtaining covered services from a noncontracted provider, which is a point of service or po…

31A-8-601. Definitions. Reserved.

31A-8-602. Ambulance membership plan requirements. (1) An ambulance membership organization may assess a one-time application processing fee to the ambulance membership organization's members that may not exceed $25. (2) If an ambulance membership organization cancels an ambulanc…

31A-8-603. Certificate of authority renewal -- Reporting requirements. (1) At least 90 days before the day on which an ambulance membership organization's certificate of authority expires, the ambulance membership organization seeking renewal of the ambulance membership organizat…

31A-8-604. Ambulance membership restrictions -- Medicaid program. (1) An ambulance membership organization may not knowingly sell, offer for sale, or provide an ambulance membership plan to an individual who is enrolled in the Medicaid program. (2) If an individual who enters int…

31A-8-605. Marketing requirements -- Required disclosures. (1) Each advertisement, marketing material, brochure, ambulance membership card, presentation, and any other communication of an ambulance membership organization shall be truthful and not misleading in fact or in implica…