Title 33, Chapter 21, Section 10
( 33-21-10)
(a) Every health maintenance organization shall be responsible for the assumption of full financial risk of providing basic health services to its members, except that the health maintenance organization may reinsure its risks with solvent reinsurers who qualify to transact reinsurance in this state under Code Section 33-7-14 and may enter into reinsurance treaties or agreements with such reinsurers in order to obtain reinsurance for: (1) The cost of providing basic health services which exceeds in
the aggregate $5,000.00 per member per year; (2) The cost of providing basic health services to members when
they are outside the health maintenance organization's service
area; and (3) Not more than 90 percent of the amount of which the health
maintenance organization's costs for any fiscal year exceed 115
percent of its income for that fiscal year, provided that all
reinsurance treaties and agreements entered into by health
maintenance organizations shall under this Code section also be
required to meet the same standards as would be required by this
title for reinsurance treaties or agreements made by a property
and casualty insurer as a ceding insurer. (b) Each health maintenance organization shall deposit with the
Commissioner cash or securities acceptable to the Commissioner in
the amount of $100,000.00, provided that the Commissioner shall also
have the authority to require such additional amounts of deposits as
he may deem necessary to protect the enrollees of the health
maintenance organization. The deposits shall be administered by the
Commissioner pursuant to Chapter 12 of this title. The Commissioner
shall also have the authority to waive, modify, or authorize
accumulation and incremental adjustments of such deposits as he
deems necessary to protect the enrollees of the health maintenance
organization. |