US Laws, Codes, Statutes & Cases

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 39
                             MANAGED CARE REFORM
    41-3919.  OPEN ENROLLMENT. (1) Requirement of an open enrollment period is
intended to provide the benefits of  managed care to the general public or to
all members of the class of persons the managed care organization serves. Such
requirement is not intended to prohibit a managed care organization from
establishing administrative procedures that protect the quality of service to
its members or the financial condition of the organization. However, during
periods of open enrollment the organization shall not establish any
administrative procedure that arbitrarily and unreasonably restricts
enrollment.
    (2)  After the initial twenty-four (24) months of operation every managed
care organization shall have an annual open enrollment period of at least one
(1) month during which it accepts members, without restrictions up to the
limits of its capacity except as provided in subsection (3) of this section,
as determined by the managed care organization, in the order in which they
apply for enrollment. Managed care organizations organized to provide services
exclusively to a specified group or groups of individuals may limit  such open
enrollment to all members of such group(s).
    (3)  A managed care organization may apply to the director for
authorization to impose underwriting restrictions upon enrollment. The
director shall, within thirty (30) days, approve the application if he
determines that such restrictions will:
    (a)  Preserve the financial stability of the managed care organization; or
    (b)  Prevent excessive adverse selection of prospective members; or
    (c)  Avoid unreasonably high or unmarketable charges for member coverage
    for health care services.
If the application cannot be approved the director must deny it within the
thirty (30) day period.