Title 33, Chapter 21, Section 26
( 33-21-26)
(a) No health maintenance organization or representative of a health
maintenance organization may cause or knowingly permit the use of
advertising which is untrue or misleading, solicitation which is
untrue or misleading, or any form of evidence of coverage which is
deceptive. For purposes of this Code section: (1) A statement or item of information shall be deemed to be
untrue if it does not conform to fact in any respect which is or
may be significant to an enrollee of, or person considering
enrollment in, a health benefits plan; (2) A statement or item of information shall be deemed to be
misleading, whether or not it may be literally untrue, if, in the
total context in which the statement is made or the item of
information is communicated, the statement or item of information
may be reasonably understood by a reasonable person not possessing
special knowledge regarding health care coverage as indicating any
benefit or advantage or the absence of any exclusion, limitation,
or disadvantage of possible significance to an enrollee of, or
person considering enrollment in, a health benefits plan, if the
benefit or advantage or absence of limitation, exclusion, or
disadvantage does not in fact exist; and (3) An evidence of coverage shall be deemed to be deceptive if the
evidence of coverage taken as a whole, and with consideration
given to typography and format, as well as language, shall be such
as to cause a reasonable person not possessing special knowledge
regarding health benefits plans and evidences of coverage for the
health benefits plan to expect benefits, services, charges, or
other advantages which the evidence of coverage does not provide
or which the health benefits plan issuing the evidence of coverage
does not regularly make available for enrollees covered under
evidence of coverage. (b) The provisions of Chapter 6 of this title applicable to insurers
shall apply to health maintenance organizations in this chapter and,
for the purpose of determining whether a violation of Chapter 6 of
this title has occurred, an "enrollee" as defined in this chapter
shall be deemed to be an insured or a policyholder as used in
Chapter 6 of this title, whichever is applicable. (c) An enrollee may not be canceled or nonrenewed except for the
failure to pay the charge for such coverage or for such other
reasons as may be promulgated by the Commissioner. |