If a health maintenance organization determines that an enrollee has received health care services that the enrollee is not entitled to receive under the terms of the health maintenance agreement, the organization may not recover an amount above the actual cost of providing the health care service. This section does not apply if the enrollee gave or withheld information to the health maintenance organization with the intent to mislead or misinform the organization as to the enrollee's right to receive the health care services.
Structure Alaska Statutes
Chapter 86. Health Maintenance Organizations
Sec. 21.86.010. Establishment of health maintenance organizations.
Sec. 21.86.020. Issuance of certificate of authority; approval of changes.
Sec. 21.86.030. Powers of a health maintenance organization.
Sec. 21.86.040. Governing body; enrollee participation.
Sec. 21.86.045. Biographical affidavits.
Sec. 21.86.050. Fiduciary responsibility.
Sec. 21.86.060. Provision of services.
Sec. 21.86.070. Evidence of coverage; charges for health care services.
Sec. 21.86.075. Chiropractic health care services.
Sec. 21.86.078. Choice of health care provider.
Sec. 21.86.080. Annual statement; additional reports.
Sec. 21.86.090. Information to enrollees.
Sec. 21.86.100. Complaint system; report.
Sec. 21.86.110. Recovery of health care costs.
Sec. 21.86.120. Return of agreement.
Sec. 21.86.140. Protection against insolvency.
Sec. 21.86.150. Prohibited practices.
Sec. 21.86.160. Regulation of agents.
Sec. 21.86.170. Powers of insurers and of hospital or medical service corporations.
Sec. 21.86.190. Suspension or revocation of certificate of authority.
Sec. 21.86.200. Administrative procedures.
Sec. 21.86.210. Rehabilitation, liquidation, or conservation.
Sec. 21.86.250. Penalties and enforcement.
Sec. 21.86.260. Statutory construction and relationship to other law.
Sec. 21.86.270. Filings and reports as public documents.
Sec. 21.86.290. Contract authority for commissioner of health.
Sec. 21.86.300. Acquisition of control or merger of a health maintenance organization.