TITLE 27
Insurance
CHAPTER 27-41
Health Maintenance Organizations
SECTION 27-41-18
§ 27-41-18 Rehabilitation, liquidation, or
conservation of health maintenance organization.
(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 and shall be conducted under the
supervision of the director of business regulation pursuant to chapters 14.1,
14.2, and 14.3 of this title. The director of business regulation may apply for
an order from the superior court directing the director to rehabilitate,
liquidate, or conserve a health maintenance organization upon any one or more
of the grounds included in chapter 14.3 of this title or upon any one or more
of the following grounds:
(1) That the health maintenance organization is insolvent;
(2) That the health maintenance organization is in an unsound
financial condition;
(3) That the health maintenance organization's business
policies are unsound or improper;
(4) That the health maintenance organization's condition or
management is such as to render its further transaction of business hazardous
to the public or its enrollees;
(5) That the health maintenance organization's funds, net
cash, or contingent assets are deficient; or
(6) That the health maintenance organization is conducting
its business fraudulently or refuses or neglects to comply with the laws of
this state.
(b) A claim by a health care provider who agrees not to
assert that claim against any enrollee of the health maintenance organization
for an uncovered expenditure has priority over other providers of services.
(c) For purposes of determining the priority of distribution
of general assets, claims of enrollees and enrollees' beneficiaries shall have
the same priority as established in chapter 14.3 of this title for
policyholders and beneficiaries of insureds of insurance companies. If an
enrollee is liable to a provider for services provided pursuant to and covered
by the health benefit plan, that liability shall have the status of an enrollee
claim for distribution of general assets. A provider who is obligated by
statute or agreement to hold enrollees harmless from liability for services
provided pursuant to and covered by a health benefit plan shall have a priority
of distribution of the general assets immediately following that of enrollees
and enrollees' beneficiaries as described herein, and immediately preceding the
priority of distribution for priority Class 7 described in § 27-14.3-46.
History of Section.
(P.L. 1983, ch. 225, § 2; P.L. 1991, ch. 370, § 4; P.L. 2005, ch.
176, § 1.)