Title 26 — Title 26 — Insurance Code
56 chapters · 1,242 sections in this title.
W.S. § 26-34-101 Short title
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Short title. This chapter is known and may be cited as "The Health Maintenance Organization Act of 1995".
W.S. § 26-34-102 (a) Definitions
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(a) Definitions. As used in this chapter: (i) "Administrator" means the director of the department of health; (ii) "Basic health care services" means emergency care, inpatient hospital and physician care, and outpatient medical services, but does not include mental health service…
W.S. § 26-34-103 organizations
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organizations. Establishment of health maintenance (a) 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 chapter. No per…
W.S. § 26-34-104 Issuance of certificate of authority
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Issuance of certificate of authority. (a) Upon receipt of an application for issuance of a certificate of authority, the commissioner shall immediately transmit a copy of the application and accompanying documents to the administrator. (b) The administrator shall determine whethe…
W.S. § 26-34-105 Powers of health maintenance organizations
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Powers of health maintenance organizations. (a) The powers of a health maintenance organization include but are not limited to the: (i) Purchase, lease, construction, renovation, operation or maintenance of hospitals or medical facilities, or both, and their ancillary equipment, …
W.S. § 26-34-106 Governing body
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Governing body. (a) The governing body of any health maintenance organization may include providers, or other individuals, or both. (b) Repealed by Laws 1995, ch. 210, § 5. (c) Any domestic health maintenance organization shall comply with the requirements applicable to a domesti…
W.S. § 26-34-107 Fiduciary responsibilities
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Fiduciary responsibilities. (a) Any director, officer, employee or partner of a health maintenance organization who receives, handles, collects, disburses or invests funds in connection with the activities of the organization is responsible for those funds in a fiduciary relation…
W.S. § 26-34-108 Quality assurance program
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Quality assurance program. (a) The health maintenance organization shall establish procedures to assure that the health care services provided to enrollees are rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of…
W.S. § 26-34-109 Requirements for group contract, individual contract, evidence of coverage and premiums for health care services
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Requirements for group contract, individual contract, evidence of coverage and premiums for health care services. (a) Every group and individual contract holder is entitled to a group or individual contract. The contract shall not contain provisions or statements which are unjust…
W.S. § 26-34-110 Annual report
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Annual report. (a) Each health maintenance organization, annually, on or before March 1, shall file with the commissioner, with a copy to the administrator, a report verified by at least two (2) organization principal officers and covering the immediately preceding calendar year.…
W.S. § 26-34-111 Information to enrollees; claims to be accepted or rejected; attorney's fees
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Information to enrollees; claims to be accepted or rejected; attorney's fees. (a) Each health maintenance organization shall: (i) Provide promptly to its enrollees notice of any material change in the operation of the organization that will directly affect those enrollees; (ii) P…
W.S. § 26-34-112 Complaint system
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Complaint system. (a) Each health maintenance organization shall establish and maintain a complaint system which has been approved by the commissioner, after consultation with the administrator, to provide reasonable procedures for the resolution of written complaints initiated b…
W.S. § 26-34-113 Investments
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Investments. With the exception of investments made in accordance with W.S. 26-34-105(a)(i), the funds of a health maintenance organization shall be invested only in securities or other investments permitted by chapter 7 of this code.
W.S. § 26-34-114 Protection against insolvency
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Protection against insolvency. (a) 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…
W.S. § 26-34-115 Uncovered expenditures insolvency deposit
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Uncovered expenditures insolvency deposit. (a) 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, or with any organizat…
W.S. § 26-34-116 Enrollment period, replacement coverage in the event of insolvency
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Enrollment period, replacement coverage in the event of insolvency. (a) 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 organiza…
W.S. § 26-34-117 Prohibited practices
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Prohibited practices. (a) No health maintenance organization, or representative thereof, shall cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading or any form of evidence of coverage which is deceptive. For pu…
W.S. § 26-34-118 producers
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producers. Regulation of health maintenance organization (a) The commissioner, after notice and hearing, may promulgate reasonable rules and regulations as necessary to provide for the licensing of health maintenance organization producers. The rules shall establish: (i) The requ…
W.S. § 26-34-119 Powers of insurers and hospital and health service corporations
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Powers of insurers and hospital and health service corporations. (a) Any insurance company licensed in this state, or a hospital or health service corporation authorized to do business in this state, either directly or through a subsidiary or affiliate, may organize and operate a…
W.S. § 26-34-120 Examination
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Examination. (a) The commissioner may make an examination of the affairs of any health maintenance organization and providers with whom that organization has contracts, agreements or other arrangements as often as is reasonably necessary for the protection of the interests of the…
W.S. § 26-34-121 authority
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authority. Suspension or revocation of certificate of (a) The commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if: (i) organization: The commissioner finds the health maintenance (A) Is operating signif…
W.S. § 26-34-122 Rehabilitation, liquidation or conservation of a health maintenance organization
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Rehabilitation, liquidation or conservation of a health maintenance organization. (a) Any rehabilitation, liquidation or conservation of a health maintenance organization is deemed to be the rehabilitation, liquidation or conservation of an insurance company and shall be conducte…
W.S. § 26-34-123 Summary orders and supervision
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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 violated any pro…
W.S. § 26-34-124 Regulations
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Regulations. The commissioner, after notice and hearing, may promulgate reasonable rules and regulations necessary or proper to carry out this chapter. The rules and regulations are subject to review in accordance with W.S. 28-9-101 through 28-9-108.
W.S. § 26-34-125 Administrative procedures
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Administrative procedures. (a) If the commissioner 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 or for the imposition of an administrative pe…
W.S. § 26-34-126 Fees; taxes
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Fees; taxes. (a) Each health maintenance organization subject to this chapter shall pay to the commissioner the following fees: (i) For filing an application for a certificate of authority or amendment thereto, seven hundred fifty dollars ($750.00); (ii) For annual certificate of…
W.S. § 26-34-127 Penalties and enforcement
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Penalties and enforcement. (a) The commissioner, instead of suspension or revocation of a certificate of authority under W.S. 26-34-121, may levy an administrative penalty in an amount not less than one thousand dollars ($1,000.00) nor more than ten thousand dollars ($10,000.00) …
W.S. § 26-34-128 other laws
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other laws. Statutory construction and relationship to (a) Except as otherwise specifically provided in this chapter, the other provisions of this code relating to insurers and the provisions of title 35 of the Wyoming statutes relating to hospitals or medical service corporation…
W.S. § 26-34-129 Filings and reports as public documents
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Filings and reports as public documents. All applications, filings and reports required under this chapter, except those which are trade secrets or privileged or confidential quality assurance, commercial or financial information, other than any annual financial statement that ma…
W.S. § 26-34-130 Confidentiality of medical information
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Confidentiality of medical information. (a) Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from that person or from any provider by any health maintenance organization shall be held in confidence and shall not be dis…
W.S. § 26-34-131 Administrator's authority to contract
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Administrator's authority to contract. The administrator, in carrying out his obligations under this chapter may contract with qualified persons to make recommendations concerning the determinations he is required to make. The administrator may accept the recommendations in full …
W.S. § 26-34-132 Acquisition of control of or merger of a health maintenance organization
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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, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health m…
W.S. § 26-34-133 Coordination of benefits
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Coordination of benefits. (a) 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 …
W.S. § 26-34-134 Written agreement with providers; discrimination prohibited
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Written agreement with providers; discrimination prohibited. (a) Before entering into any written agreement with any provider for the furnishing of health care services to enrollees of a health maintenance organization the organization shall establish terms and conditions to be r…
W.S. § 26-34-135 Application of other laws
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Application of other laws. (a) The annual audited financial reports law, title 26, chapter 3, article 3 of the Wyoming statutes, shall apply to domestic health maintenance organizations licensed under this chapter. (b) The Wyoming Insurance Holding Company System Regulatory Act, …