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

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

(2)  Participate in transactions between affiliatedentities, including loans and the transfer of responsibility under allproviders, subscribers, and other contracts between affiliates or between thehealth maintenance organization and its parent;

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

(4)  Contracting with any person for the performanceon its behalf of certain functions such as marketing, enrollment, andadministration;

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

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

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

(8)  Offering a point of service product consistingof:

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

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

(b)  A health maintenance organization shallfile notice, with adequate supporting information, with the commissioner priorto the exercise of any power granted in subsection (a)(1), (2), or (4) whichmay affect the financial soundness of the health maintenance organization.  Thecommissioner shall disapprove such exercise of power only if in thecommissioner's opinion it would substantially and adversely affect thefinancial soundness of the health maintenance organization and endanger itsability to meet its obligations.  If the commissioner does not disapprove therequest within thirty days of the filing of the notice, it shall be deemedapproved.  The commissioner may adopt rules exempting from the filingrequirement of this subsection those activities having a minimal effect. [L1995, c 179, pt of §1]