§ 27-41-35 - Enrollment period in the event of insolvency. - Rhode Island Statutes

SECTION 27-41-35

   § 27-41-35  Enrollment period in the eventof insolvency. – (a) In the event of an insolvency of a health maintenance organization, uponorder of the director, all other carriers that participated in the enrollmentprocess with the insolvent health maintenance organization at a group's lastregular enrollment period shall offer the group's enrollees of the insolventhealth maintenance organization a thirty (30) day enrollment period commencingupon the date of insolvency. Each carrier shall offer the enrollees of theinsolvent health maintenance organization the same coverage and rates that ithad offered to the enrollees of the group at its last regular enrollment period;

   (b) If no other carrier had been offered to some groupsenrolled in the insolvent health maintenance organization, or if the directordetermines that the other health benefit plan(s) lack(s) sufficient health caredelivery resources to assure that health care services will be available andaccessible to all of the group enrollees of the insolvent health maintenanceorganization, then the director shall allocate equitably the insolvent healthmaintenance organization's group contracts for the groups among all healthmaintenance organizations which operate within a portion of the insolventhealth maintenance organization's service area, taking into consideration thehealth care delivery resources of each health maintenance organization. If thedirector determines that no health maintenance organization has sufficientresources to assure that health care services will be available and accessibleto some groups enrolled in the insolvent health maintenance organization, thenthe director shall allocate equitably the insolvent health maintenanceorganization's contracts for the groups among the other carriers as he or shedeems appropriate. Each health maintenance organization, or other carrier, towhich a group or groups are so allocated shall offer the group or groups thehealth maintenance organization's or other carrier's existing coverage which ismost similar to each group's coverage with the insolvent health maintenanceorganization at rates determined in accordance with the successor healthmaintenance organization's or other carrier's existing rating methodology;

   (c) The director shall also allocate equitably the insolventhealth maintenance organization's nongroup enrollees that are unable to obtainother coverage among all health maintenance organizations which operate withina portion of the insolvent health maintenance organization's service area,taking into consideration the health care delivery resources of each healthmaintenance organization. If the director determines that no health maintenanceorganization has sufficient resources to assure that health care services willbe available and accessible to some nongroup enrollees of the insolvent healthmaintenance organization, then the director shall allocate equitably theinsolvent health maintenance organization's contracts for the nongroupenrollees among the other carriers as he or she deems appropriate. Each healthmaintenance organization or other carrier to which nongroup enrollees areallocated shall offer the nongroup enrollees the health maintenanceorganization's or other carrier's existing coverage for individual orconversion coverage as determined by his or her type of coverage in theinsolvent health maintenance organization at rates determined in accordancewith the successor health maintenance organization's or other carrier'sexisting rating methodology. Successor health maintenance organizations orother carriers that do not offer direct nongroup enrollment may aggregate allof the allocated nongroup enrollees into one group for rating and coveragepurposes.