Alabama Administrative Code
Title 482 - ALABAMA DEPARTMENT OF INSURANCE
Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY
Section 482-1-079-.14 - Insurance - General Liability, Medical Malpractice And Reinsurance
Current through Register Vol. 42, No. 5, February 29, 2024
Evidence of the existence of insurance or a plan for self-insurance approved by the Commissioner must be submitted at least 30 days prior to the expiration date of the policy and with each annual report.
Unless the Commissioner grants an exemption from requirements of this section, the HMO shall secure insurance coverage or furnish evidence of acceptable self-insurance to provide:
(1) For payments or services required to be made or furnished under the health care contract to those enrollees who are injured or become ill outside the geographical limits served by the HMO;
(2) Reinsurance protection to the HMO in the event of catastrophic or unusual losses in excess of levels of loss which the HMO assumes in the basis of its calculation of premium charges (schedule of charges);
(3) That the HMO has an agreement with an Alabama licensed insurer or nonprofit health service plan under which the insurer or nonprofit health service plan agrees to issue to enrollees in the HMO, a plan of hospital, medical and surgical insurance at standard conversion premium rates without any underwriting or other requirement, other than an application and payment of the first monthly premium by the enrollee, in the event the HMO is unable to continue in operation;
(4) For a general liability and medical malpractice plan or an adequate plan for self-insurance program approved by the Commissioner. Evidence of these plans must be submitted at least 30 days prior to the expiration date of the policy and with each annual report.
Author: Commissioner of Insurance
Statutory Authority: Code of Ala. 1975, §§ 27-2-17, 27-21A-19.
