44-4721. Suspension or revocation of certificate of authority.

459 words·~2 min read·/ne/chapter-44/44-4721

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(1)The director may suspend or revoke any certificate of authority issued to a prepaid limited health service organization pursuant to the Prepaid Limited Health Service Organization Act upon determining that any of the following conditions exists:

(a)The prepaid limited health service organization is operating significantly in contravention of its basic organizational document or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to section 44-4704 unless amendments to such submissions have been filed with and approved by the director;

(b)The prepaid limited health service organization issues an evidence of coverage or uses rates or charges which do not comply with the requirements of section 44-4709 or 44-4710 ;

(c)The prepaid limited health service organization is unable to fulfill its obligations to furnish limited health services;

(d)The prepaid limited health service organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;

(e)The prepaid limited health service organization has failed to implement the complaint system required by section 44-4713 in a reasonable manner to resolve valid complaints;

(f)The continued operation of the prepaid limited health service organization would be hazardous to its enrollees;

(g)The tangible net equity of the prepaid limited health service organization is less than that required by section 44-4718 or the prepaid limited health service organization has failed to correct any deficiency in its tangible net equity as required by the director; and

(h)The prepaid limited health service organization has otherwise failed to substantially comply with the act.

(2)If the director has cause to believe that grounds for the suspension or revocation of a certificate of authority exist, he or she shall notify the prepaid limited health service organization in writing by certified mail specifically stating the grounds for suspension or revocation and fixing a time not more than sixty days thereafter for a hearing on the matter. Any decision of the director may be appealed. The appeal shall be in accordance with the Administrative Procedure Act.

(3)When the certificate of authority of a prepaid limited health service organization is revoked, such 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 orderly conclusion of the affairs of such organization. It shall engage in no further advertising or solicitation whatsoever. The director may, by written order, permit such further operation of the organization as he or she may find to be in the best interest of enrollees to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing limited health services.