26.1-18.1-04. Powers of health maintenance organizations

26.1-18.1-04. Powers of health maintenance organizations

1. The powers of a health maintenance organization include the following:

a. The purchase, lease, construction, renovation, operation, or maintenance of

hospitals, medical facilities, or both, and their ancillary equipment, and such

property as may reasonably be required for its principal office or for such

purposes as may be necessary in the transaction of the business of the

organization.

b. Transactions between affiliated entities, including loans and the transfer of

responsibility under all contracts between affiliates or between the health

maintenance organization and its parent.

c. The furnishing of health care services through providers, provider associations, or

agents for providers which are under contract with or employed by the health

maintenance organization.

d. The contracting with any person for the performance on its behalf of certain

functions such as marketing, enrollment, and administration.

e. The contracting with an insurance company licensed in this state, or with a

hospital or medical service corporation authorized to do business in this state, for

the provision of insurance, indemnity, or reimbursement against the cost of health

care services provided by the health maintenance organization.

f. The offering of other health care services, in addition to basic health care

services. Nonbasic health care services may be offered by a health maintenance

organization on a prepaid basis without offering basic health care services to any

group or individual.

g. The joint marketing of products with an insurance company licensed in this state

or with a hospital or medical service corporation authorized to do business in this

state as long as the company that is offering each product is clearly identified.

2. a. A health maintenance organization shall file notice, with adequate supporting

information, with the commissioner prior to the exercise of any power granted in

subdivisions a, b, and d of subsection 1 which may affect the financial soundness

of the health maintenance organization. The commissioner shall disapprove the

exercise of power only if in the commissioner's opinion it would substantially and

adversely affect the financial soundness of the health maintenance organization

and endanger its ability to meet its obligations.

b. The commissioner may adopt rules exempting from the filing requirement of

subdivision a those activities having a de minimis effect.