§ 27-41-18 - Rehabilitation, liquidation, or conservation of health maintenance organization. - Rhode Island Statutes

SECTION 27-41-18

   § 27-41-18  Rehabilitation, liquidation, orconservation of health maintenance organization. – (a) Any rehabilitation, liquidation, or conservation of a health maintenanceorganization shall be deemed to be the rehabilitation, liquidation, orconservation of an insurance company and shall be conducted under thesupervision 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 foran order from the superior court directing the director to rehabilitate,liquidate, or conserve a health maintenance organization upon any one or moreof the grounds included in chapter 14.3 of this title or upon any one or moreof the following grounds:

   (1) That the health maintenance organization is insolvent;

   (2) That the health maintenance organization is in an unsoundfinancial condition;

   (3) That the health maintenance organization's businesspolicies are unsound or improper;

   (4) That the health maintenance organization's condition ormanagement is such as to render its further transaction of business hazardousto the public or its enrollees;

   (5) That the health maintenance organization's funds, netcash, or contingent assets are deficient; or

   (6) That the health maintenance organization is conductingits business fraudulently or refuses or neglects to comply with the laws ofthis state.

   (b) A claim by a health care provider who agrees not toassert that claim against any enrollee of the health maintenance organizationfor an uncovered expenditure has priority over other providers of services.

   (c) For purposes of determining the priority of distributionof general assets, claims of enrollees and enrollees' beneficiaries shall havethe same priority as established in chapter 14.3 of this title forpolicyholders and beneficiaries of insureds of insurance companies. If anenrollee is liable to a provider for services provided pursuant to and coveredby the health benefit plan, that liability shall have the status of an enrolleeclaim for distribution of general assets. A provider who is obligated bystatute or agreement to hold enrollees harmless from liability for servicesprovided pursuant to and covered by a health benefit plan shall have a priorityof distribution of the general assets immediately following that of enrolleesand enrollees' beneficiaries as described herein, and immediately preceding thepriority of distribution for priority Class 7 described in § 27-14.3-46.