IC 27-13-24
    Chapter 24. Suspension, Revocation, or Denial of Certificate ofAuthority

IC 27-13-24-1
Grounds for suspension or revocation
    Sec. 1. (a) The commissioner may suspend or revoke a certificateof authority issued under this article or deny an application submittedunder this article if the commissioner finds that any of the followingconditions exists:
        (1) The health maintenance organization is operating:
            (A) significantly in contravention of its basic organizationaldocument; or
            (B) in a manner contrary to that described in any otherinformation submitted under IC 27-13-2;
        unless amendments to the basic organizational document orother submissions that are consistent with the operations of theorganization have been filed with and approved by thecommissioner.
        (2) The health maintenance organization:
            (A) issues an evidence of coverage;
            (B) enters into a contract with a participating provider; or
            (C) uses a schedule of charges for health care services;
        that does not comply with the requirements of IC 27-13-7,IC 27-13-15, and IC 27-13-20.
        (3) The health maintenance organization does not provide orarrange for basic health care services.
        (4) The commissioner determines that the health maintenanceorganization is unable to fulfill its obligations to furnish healthcare coverage.
        (5) The health maintenance organization is no longer financiallyresponsible and may reasonably be expected to be unable tomeet its obligations to enrollees or prospective enrollees.
        (6) The health maintenance organization has failed to correct,within the time prescribed by section 2 of this chapter, anydeficiency occurring due to the impairment of the prescribedminimum net worth of the health maintenance organization.
        (7) The health maintenance organization has failed toimplement the grievance procedures required by IC 27-13-10 ina reasonable manner to resolve valid complaints.
        (8) The health maintenance organization or any person actingon behalf of the organization has intentionally advertised ormerchandised the services of the organization in an untrue, amisrepresentative, a misleading, a deceptive, or an unfairmanner.
        (9) The continued operation of the health maintenanceorganization would be hazardous to the enrollees of theorganization.
        (10) The health maintenance organization fails to comply withthe requirements provided under IC 27-13-36 through

IC 27-13-40.
        (11) The health maintenance organization has otherwise failedsubstantially to comply with this article.
    (b) The commissioner, in a proceeding under IC 4-21.5-3-8, mayimpose a civil penalty of not more than twenty-five thousand dollars($25,000) against a health maintenance organization for each causelisted in subsection (a). The civil penalties may not exceed onehundred thousand dollars ($100,000) for any one (1) healthmaintenance organization in one (1) calendar year. The penalty maybe imposed in addition to or instead of a suspension or revocation ofthe certificate of authority of the health maintenance organization.
As added by P.L.26-1994, SEC.25. Amended by P.L.69-1998,SEC.10.

IC 27-13-24-2
Deficient net worth
    Sec. 2. (a) If the commissioner finds that the net worth maintainedby a health maintenance organization subject to this article is lessthan the minimum net worth required by IC 27-13-12, thecommissioner shall:
        (1) give written notice to the health maintenance organizationof the amount of the deficiency; and
        (2) require the health maintenance organization to:
            (A) file with the commissioner a plan for correction of thedeficiency that is acceptable to the commissioner; and
            (B) correct the deficiency within a reasonable time, not toexceed sixty (60) days, unless an extension of time, not toexceed an additional sixty (60) days, is granted by thecommissioner.
    (b) A deficiency described in subsection (a) is an impairment, andthe failure of a health maintenance organization to correct theimpairment in the time prescribed by the commissioner undersubsection (a) is grounds for:
        (1) the suspension or revocation of the certificate of authorityof the organization; or
        (2) placing the health maintenance organization in rehabilitationor liquidation.
As added by P.L.26-1994, SEC.25.

IC 27-13-24-3
Procedures; written order; revised application; hearing
    Sec. 3. (a) The commissioner may:
        (1) suspend or revoke a certificate of authority;
        (2) deny an application for a certificate of authority; or
        (3) impose an administrative penalty;
under this article only after complying with this section.
    (b) The commissioner may:
        (1) suspend or revoke a certificate of authority;
        (2) deny an application for a certificate of authority; or
        (3) impose an administrative penalty;under this section by written order that shall be sent to the healthmaintenance organization or applicant by certified or registered mail.In the case of an application for a certificate of authority, the writtenorder must be sent within one hundred twenty (120) days after thesubmission of a completed application. Failure by the commissionerto issue an order within the one hundred twenty (120) day periodconstitutes approval of the application for a certificate of authority.The written order must state the grounds, charges, or conduct onwhich the suspension, revocation, denial, or administrative penaltyis based. The health maintenance organization or applicant may inwriting request a hearing within thirty (30) days after the date of themailing of the order. If a written request is not made, the order isfinal upon expiration of the thirty (30) days.
    (c) If an order is issued under subsection (b) denying anapplication for a certificate of authority, the applicant may initiatethe following procedure:
        (1) The applicant may submit to the commissioner a revisedapplication or any other information or material addressing thereasons the commissioner denied the application. A revisedapplication and other information submitted to thecommissioner under this subdivision must be submitted withinthirty (30) days after receiving the order, unless the applicantrequests an extension of time from the commissioner, who maynot unreasonably deny the request.
        (2) Upon receiving an applicant's revised application or otherinformation or materials as described in subdivision (1), thecommissioner shall promptly review the materials regardless ofwhether the applicant has requested a hearing under subsection(b).
        (3) An applicant's submission of a revised application or otherinformation or materials is considered to correct and resolve thereasons for denying the original application for a certificate ofauthority. The application or revised application is consideredto be approved unless the commissioner notifies the applicantin writing by certified or registered mail, within fifteen (15)business days after the date the submission under subdivision(1) is made, that the application or revised application is notapproved. A written notification under this subdivision muststate in detail the reasons for continuing to deny the applicationor the revised application.
    (d) If the health maintenance organization or applicant requests ahearing under this chapter, the commissioner shall issue a writtennotice of hearing and send the notice to the health maintenanceorganization or applicant by certified or registered mail. The noticemust contain a specific date and time for the hearing, which may notbe less than twenty (20) days or more than sixty (60) days after themailing of the notice of hearing.
As added by P.L.26-1994, SEC.25. Amended by P.L.195-1996,SEC.8.
IC 27-13-24-4
Action by commissioner after hearing
    Sec. 4. (a) After a hearing, or upon failure of the healthmaintenance organization or applicant to appear at the hearing, thecommissioner shall:
        (1) take whatever action the commissioner finds necessary andappropriate based on written findings; and
        (2) mail the decision to the health maintenance organization orapplicant.
    (b) The action of the commissioner under this chapter is subjectto review under IC 4-21.5.
As added by P.L.26-1994, SEC.25.

IC 27-13-24-5
Application of IC 4-21.5
    Sec. 5. IC 4-21.5 applies to proceedings under this chapter to theextent IC 4-21.5 does not conflict with any section of this chapter.
As added by P.L.26-1994, SEC.25.

IC 27-13-24-6
Prohibited activity during suspension
    Sec. 6. A health maintenance organization whose certificate ofauthority is suspended may not, during the period of suspension:
        (1) enroll any additional enrollees, except newborn children orother newly acquired dependents of existing enrollees; or
        (2) engage in any advertising or solicitation.
As added by P.L.26-1994, SEC.25.

IC 27-13-24-7
Conclusion of affairs following revocation of certificate ofauthority
    Sec. 7. (a) A health maintenance organization whose certificate ofauthority is revoked:
        (1) shall proceed, immediately following the effective date ofthe order of revocation, to wind up the affairs of theorganization; and
        (2) may not conduct further business, except as essential to theorderly conclusion of the affairs of the organization.
    (b) After the certificate of authority of a health maintenanceorganization is revoked, the health maintenance organization may notengage in further advertising or solicitation.
    (c) Notwithstanding subsection (a), the commissioner may, bywritten order, permit further operation of a health maintenanceorganization after the certificate of authority of the organization isrevoked if the commissioner finds the further operation of theorganization to be in the best interest of enrollees.
As added by P.L.26-1994, SEC.25.

IC 27-13-24-8
Prohibited activities before hearing    Sec. 8. If the commissioner issues an order under section 3(b)(1)of this chapter and the health maintenance organization requests ahearing under section 3(d) of this chapter within the time periodspecified, the health maintenance organization may not:
        (1) enroll any additional enrollees, except newborn children orother newly acquired dependents of existing enrollees; or
        (2) engage in any advertising or solicitation;
until the commissioner takes action under section 4 of this chapter.
As added by P.L.26-1994, SEC.25. Amended by P.L.195-1996,SEC.9.