58-41-81. Suspension or revocation of certificate of authority on findings by director.
297 words·~1 min read·
/sd/title-58/chapter-58-41/58-41-81A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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 its basic organizational document, its health maintenance contract, or in a manner contrary to that described in and reasonably inferred from any other information submitted under this chapter, unless amendments to such submissions have been filed with and approved by the director;
(2)The health maintenance organization issues evidence of coverage or uses a schedule or charges for health care services which do not comply with the requirements of §§ 58-41-34 to 58-41-45 , inclusive;
(3)The health care plan does not provide or arrange for comprehensive health maintenance services;
(4)The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;
(5)The health maintenance organization has failed to implement a mechanism affording the enrollees an opportunity to participate in matters of policy and operation under the provisions of §§ 58-41-23 and 58-41-24 ;
(6)The health maintenance organization has failed to implement the complaint system in a manner designed to reasonably resolve valid complaints;
(7)The health maintenance organization, or any person acting with its sanction, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;
(8)The continued operation of the health maintenance organization would be hazardous to its enrollees; or
(9)The health maintenance organization has otherwise failed to substantially comply with this chapter, has violated a provision of chapter 58-33 or any other provision of law applicable to health maintenance organizations, or has submitted false information in any report required hereunder.