[§432D-3]  Powers of health maintenance
organizations.  (a)  The powers of a health maintenance organization
include the following:



(1)  Purchase, lease, construction, renovation,
operation, or maintenance of hospitals, medical facilities, or both, and their
ancillary equipment, and such property as may reasonably be required for its
principal office or for such purposes as may be necessary in the transaction of
the business of the organization;



(2)  Participate in transactions between affiliated
entities, including loans and the transfer of responsibility under all
providers, subscribers, and other contracts between affiliates or between the
health maintenance organization and its parent;



(3)  Furnishing health care services through
providers, provider associations, or agents for providers which are under
contract with or employed by the health maintenance organization;



(4)  Contracting with any person for the performance
on its behalf of certain functions such as marketing, enrollment, and
administration;



(5)  Contracting with an insurance company licensed in
this State, or with a hospital or medical service corporation authorized to do
business in this State, for the provision of insurance, indemnity, or
reimbursement against the cost of health care services provided by the health
maintenance organization;



(6)  Offering other health care services, in addition
to basic health care services.  Non-basic health care services may be offered
by a health maintenance organization on a prepaid basis without offering basic
health care services to any group or individual;



(7)  Joint marketing of products with an insurance
company licensed in this State or with a hospital or medical service
corporation authorized to do business in this State as long as the company that
is offering each product is clearly identified; and



(8)  Offering a point of service product consisting
of:



(A)  In-plan covered health care services
obtained from providers who are employed by, or otherwise affiliated with the
health maintenance organization and emergency services; and



(B)  Out-of-plan covered services consisting of
non-emergency, self-referred covered health care services obtained from
providers who are not otherwise employed by, not under contract with, and not
otherwise affiliated with the health maintenance organization, or services
obtained from affiliated specialists without a referral; provided the health
maintenance organization shall not expend more than ten per cent of its total
health care expenditures for out-of-plan covered services.



(b)  A health maintenance organization shall
file notice, with adequate supporting information, with the commissioner prior
to the exercise of any power granted in subsection (a)(1), (2), or (4) which
may affect the financial soundness of the health maintenance organization.  The
commissioner shall disapprove such exercise of power only if in the
commissioner's opinion it would substantially and adversely affect the
financial soundness of the health maintenance organization and endanger its
ability to meet its obligations.  If the commissioner does not disapprove the
request within thirty days of the filing of the notice, it shall be deemed
approved.  The commissioner may adopt rules exempting from the filing
requirement of this subsection those activities having a minimal effect. [L
1995, c 179, pt of §1]