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304.38A-090 Suspension or revocation of certificate of authority -- Notification -Winding up affairs -- Applicable provisions.
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The commissioner may suspend or revoke the certificate of authority issued to a
limited health service organization pursuant to this subtitle upon determining that
any of the following conditions exist:
(a) The limited health service organization is operating significantly in
contravention of its basic organizational document or in a manner contrary to
that described in and reasonably inferred from any other information
submitted pursuant to KRS 304.38A-030, unless amendments to the
submissions have been filed with and approved by the commissioner;
(b) The limited health service organization issues an evidence of coverage or
schedule of charges for limited health services which does not comply with
the requirements of Subtitle 17C of this chapter;
(c) The limited health service organization is unable to fulfill its obligations to
furnish limited health services;
(d) The limited health service organization is not financially responsible and may
reasonably be expected to be unable to meet its obligations to enrollees or
prospective enrollees;
(e) The net worth of the limited health service organization is less than that
required by KRS 304.38A-080 or the limited health service organization has
failed to correct any deficiency in its net worth as required by the
commissioner;
(f) The continued operation of the limited health service organization would be
hazardous to its enrollees; or
(g) The limited health service organization has otherwise failed to comply with
this subtitle.
If the commissioner has cause to believe that grounds for the suspension or
revocation of a certificate of authority exist, he or she shall notify the limited health
service organization in writing specifically stating the grounds for suspension or
revocation and fixing a time not more than sixty (60) days thereafter for a hearing
on the matter in accordance with KRS Chapter 13B.
When the certificate of authority of a limited health service organization is revoked,
the organization shall proceed immediately following the effective date of the order
of revocation to wind up its affairs, and shall conduct no further business except as
may be essential to the orderly conclusion of the affairs of the organization. It shall
engage in no further advertising or solicitation whatsoever. The commissioner may,
by written order, permit such further operation of the organization as he or she may
find to be in the best interest of enrollees, to the end that enrollees will be afforded
the greatest practical opportunity to obtain continuing limited health services.
A limited health service organization shall be subject to the provisions of KRS
304.2-210 to 304.2-300 and to the provisions of Subtitle 2 of this chapter for
determining financial condition, market conduct, and business practices.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1522, effective July 15, 2010. -- Created
2002 Ky. Acts ch. 105, sec. 18, effective July 15, 2002.
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