A. The Commission may suspend or revoke any license issued to a healthmaintenance organization under this chapter if it finds that any of thefollowing conditions exist:
1. The health maintenance organization is operating significantly at variancewith its basic organizational document, its health care plan, or in a mannercontrary to that described in and reasonably inferred from any otherinformation submitted under § 38.2-4301, unless amendments to thosesubmissions have been filed with and approved by the Commission;
2. The health maintenance organization issues an evidence of coverage or usesa schedule of charges for health care services that do not comply with therequirements of § 38.2-4306;
3. The health care plan does not provide or arrange for basic health careservices or limited health care services;
4. The health maintenance organization is no longer financially responsibleand a reasonable expectation exists that it may be unable to meet itsobligations to enrollees or prospective enrollees;
5. The health maintenance organization has failed to implement a mechanismproviding the enrollees with an opportunity to participate in matters ofpolicy and operation as provided in § 38.2-4304;
6. The health maintenance organization, or any person on its behalf, hasadvertised or merchandised its services in an untrue, misrepresentative,misleading, deceptive, or unfair manner;
7. The continued operation of the health maintenance organization would behazardous to its enrollees; or
8. The health maintenance organization has otherwise failed to substantiallycomply with the provisions of this chapter.
B. When the license of a health maintenance organization is suspended, thehealth maintenance organization shall not enroll any additional enrolleesduring the period of the suspension except newborn children or other newlyacquired dependents of existing enrollees, and shall not engage in anyadvertising or solicitation.
C. The Commission shall not revoke or suspend the license of a healthmaintenance organization upon any of the grounds set out in subsection A ofthis section until it has given the organization ten days' notice of theproposed revocation or suspension and the grounds for it, and has given theorganization an opportunity to introduce evidence and be heard. Any hearingauthorized by this section may be informal. The required notice may be waivedby the Commission and the health maintenance organization.
D. When the license of a health maintenance organization is revoked, theorganization shall proceed to wind up its affairs immediately following theeffective date of the order of revocation. The health maintenanceorganization shall conduct no further business except as may be essential tothe orderly conclusion of its affairs. It shall engage in no furtheradvertising or solicitation. The Commission may, by written order, permitfurther operation of the organization that it finds to be in the bestinterests of enrollees for the purpose of giving them the greatest practicalopportunity to obtain continuing health care coverage.
(1980, c. 720, § 38.1-880; 1986, c. 562; 1992, c. 481; 1998, c. 891.)
A. The Commission may suspend or revoke any license issued to a healthmaintenance organization under this chapter if it finds that any of thefollowing conditions exist:
1. The health maintenance organization is operating significantly at variancewith its basic organizational document, its health care plan, or in a mannercontrary to that described in and reasonably inferred from any otherinformation submitted under § 38.2-4301, unless amendments to thosesubmissions have been filed with and approved by the Commission;
2. The health maintenance organization issues an evidence of coverage or usesa schedule of charges for health care services that do not comply with therequirements of § 38.2-4306;
3. The health care plan does not provide or arrange for basic health careservices or limited health care services;
4. The health maintenance organization is no longer financially responsibleand a reasonable expectation exists that it may be unable to meet itsobligations to enrollees or prospective enrollees;
5. The health maintenance organization has failed to implement a mechanismproviding the enrollees with an opportunity to participate in matters ofpolicy and operation as provided in § 38.2-4304;
6. The health maintenance organization, or any person on its behalf, hasadvertised or merchandised its services in an untrue, misrepresentative,misleading, deceptive, or unfair manner;
7. The continued operation of the health maintenance organization would behazardous to its enrollees; or
8. The health maintenance organization has otherwise failed to substantiallycomply with the provisions of this chapter.
B. When the license of a health maintenance organization is suspended, thehealth maintenance organization shall not enroll any additional enrolleesduring the period of the suspension except newborn children or other newlyacquired dependents of existing enrollees, and shall not engage in anyadvertising or solicitation.
C. The Commission shall not revoke or suspend the license of a healthmaintenance organization upon any of the grounds set out in subsection A ofthis section until it has given the organization ten days' notice of theproposed revocation or suspension and the grounds for it, and has given theorganization an opportunity to introduce evidence and be heard. Any hearingauthorized by this section may be informal. The required notice may be waivedby the Commission and the health maintenance organization.
D. When the license of a health maintenance organization is revoked, theorganization shall proceed to wind up its affairs immediately following theeffective date of the order of revocation. The health maintenanceorganization shall conduct no further business except as may be essential tothe orderly conclusion of its affairs. It shall engage in no furtheradvertising or solicitation. The Commission may, by written order, permitfurther operation of the organization that it finds to be in the bestinterests of enrollees for the purpose of giving them the greatest practicalopportunity to obtain continuing health care coverage.
(1980, c. 720, § 38.1-880; 1986, c. 562; 1992, c. 481; 1998, c. 891.)
A. The Commission may suspend or revoke any license issued to a healthmaintenance organization under this chapter if it finds that any of thefollowing conditions exist:
1. The health maintenance organization is operating significantly at variancewith its basic organizational document, its health care plan, or in a mannercontrary to that described in and reasonably inferred from any otherinformation submitted under § 38.2-4301, unless amendments to thosesubmissions have been filed with and approved by the Commission;
2. The health maintenance organization issues an evidence of coverage or usesa schedule of charges for health care services that do not comply with therequirements of § 38.2-4306;
3. The health care plan does not provide or arrange for basic health careservices or limited health care services;
4. The health maintenance organization is no longer financially responsibleand a reasonable expectation exists that it may be unable to meet itsobligations to enrollees or prospective enrollees;
5. The health maintenance organization has failed to implement a mechanismproviding the enrollees with an opportunity to participate in matters ofpolicy and operation as provided in § 38.2-4304;
6. The health maintenance organization, or any person on its behalf, hasadvertised or merchandised its services in an untrue, misrepresentative,misleading, deceptive, or unfair manner;
7. The continued operation of the health maintenance organization would behazardous to its enrollees; or
8. The health maintenance organization has otherwise failed to substantiallycomply with the provisions of this chapter.
B. When the license of a health maintenance organization is suspended, thehealth maintenance organization shall not enroll any additional enrolleesduring the period of the suspension except newborn children or other newlyacquired dependents of existing enrollees, and shall not engage in anyadvertising or solicitation.
C. The Commission shall not revoke or suspend the license of a healthmaintenance organization upon any of the grounds set out in subsection A ofthis section until it has given the organization ten days' notice of theproposed revocation or suspension and the grounds for it, and has given theorganization an opportunity to introduce evidence and be heard. Any hearingauthorized by this section may be informal. The required notice may be waivedby the Commission and the health maintenance organization.
D. When the license of a health maintenance organization is revoked, theorganization shall proceed to wind up its affairs immediately following theeffective date of the order of revocation. The health maintenanceorganization shall conduct no further business except as may be essential tothe orderly conclusion of its affairs. It shall engage in no furtheradvertising or solicitation. The Commission may, by written order, permitfurther operation of the organization that it finds to be in the bestinterests of enrollees for the purpose of giving them the greatest practicalopportunity to obtain continuing health care coverage.
(1980, c. 720, § 38.1-880; 1986, c. 562; 1992, c. 481; 1998, c. 891.)
