2013 Mississippi Code
Title 83 - INSURANCE
Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS
Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT
§ 83-41-363 - Proceedings upon insolvency of health maintenance organization

(1) When a health maintenance organization in this state is declared insolvent by a court of competent jurisdiction, the commissioner may levy an assessment on health maintenance organizations doing business in this state to pay claims for uncovered expenditures for enrollees who are residents of this state and to provide continuation of coverage for subscribers or enrollees not covered under Section 83-41-329. The commissioner may not assess in any one (1) calendar year more than two percent (2%) of the aggregate premium written by each health maintenance organization in this state the prior calendar year.

(2) (a) The commissioner may use funds obtained under subsection (1) to pay claims for uncovered expenditures for subscribers or enrollees of an insolvent health maintenance organization who are residents of this state, provide for continuation of coverage for subscribers or enrollees who are residents of this state and are not covered under Section 83-41-329, and administrative costs. The commissioner may by regulation prescribe the time, manner and form for filing claims under this section or may require claims to be allowed by an ancillary receiver or the domestic liquidator or receiver.

(b) The Commissioner may not use funds obtained under subsection (1) to pay claims by participating providers for services rendered to subscribers or enrollees prior to insolvency of the health maintenance organization.

(3) (a) A receiver or liquidator of an insolvent health maintenance organization shall allow a claim in the proceeding in an amount equal to administrative and uncovered expenditures paid under this section.

(b) Any person receiving benefits under this section for uncovered expenditures is deemed to have assigned the rights under the covered health care plan certificates to the commissioner to the extent of the benefits received. The commissioner may require an assignment to it of such rights by any payee, enrollee, or beneficiary as a condition precedent to the receipt of any rights or benefits conferred by this section upon such person. The commissioner is subrogated to these rights against the assets of any insolvent health maintenance organization held by a receiver or liquidator of another jurisdiction.

(c) The assignment or subrogation rights of the commissioner and allowed claim under this subsection have the same priority against the assets of the insolvent health maintenance organization as those possessed by the person entitled to receive benefits under this section or for similar expenses in the receivership or liquidation.

(4) When assessed funds are unused following the completion of the liquidation of a health maintenance organization, the commissioner will distribute on a pro rata basis any amounts received under subsection (1) which are not de minimis to the health maintenance organizations which have been assessed under this section.

(5) The aggregate coverage of uncovered expenditures under this section shall not exceed Three Hundred Thousand Dollars ($ 300,000.00) with respect to any one (1) individual. Continuation of coverage shall not continue for more than the lesser of one (1) year after the health maintenance organization coverage is terminated by insolvency or the remaining term of the contract. The commissioner may provide continuation of coverage on any reasonable basis; including, but not limited to, continuation of the health maintenance organization contract or substitution of indemnity coverage in a form determined by the commissioner.

(6) The commissioner may waive an assessment of any health maintenance organization if it would be or is impaired or placed in financially hazardous condition. A health maintenance organization which fails to pay an assessment within thirty (30) days after notice is subject to a civil forfeiture of not more than One Thousand Dollars ($ 1,000.00) per day or suspension or revocation of its certificate of authority or both fine and suspension. Any action taken by the commissioner in enforcing the provisions of this section may be appealed by the health maintenance organization in accordance with the Chancery Court of the First Judicial District of Hinds County, Mississippi.