(a) The powers of a health maintenance organization include, but are not limited to the following:
(1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or both, and their ancillary equipment;
(2) The making of loans other than in the ordinary course of business, to providers under contract with it in furtherance of its program or the making of loans to a corporation or corporations in which it owns a majority interest for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees.
(3) The furnishing of health care services through providers which are under contract with or employed by the health maintenance organization.
(4) The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment, and administration.
(5) The purchase, lease, construction, or renovation of property as may reasonably be required for its principal office or for such purposes as may be necessary in the transaction of the business of the organization;
(6) The contracting with an insurance company licensed in this state to do business in this state, or a health care service plan authorized to transact business in this state, for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization.
(7) The offering of other health care services, in addition to basic health care services or other required health care services.
(b)(1) A health maintenance organization shall file notice, assuring compliance with any applicable state or federal laws, with adequate supporting information, with the commissioner prior to the exercise of any power granted in subsections (a)(1), (a)(2), or (a)(4). The commissioner shall disapprove such exercise of power only if in his opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the commissioner does not disapprove within 30 days of the filing, it shall be deemed approved.
(2) The commissioner may promulgate rules and regulations exempting from the filing requirement of subdivision (b)(1) those activities having a de minimis effect.
Structure Code of Alabama
Chapter 21A - Health Maintenance Organizations.
Section 27-21A-1 - Definitions.
Section 27-21A-2 - Establishment of Health Maintenance Organizations.
Section 27-21A-3 - Issuance of Certificate of Authority.
Section 27-21A-4 - Powers of Health Maintenance Organizations.
Section 27-21A-5 - Governing Body.
Section 27-21A-6 - Fiduciary Responsibilities of Directors, Officers, Employees, and Partners.
Section 27-21A-7 - Evidence of Coverage and Charges for Health Care Services.
Section 27-21A-8 - Reporting Requirements.
Section 27-21A-9 - Information to Enrollees.
Section 27-21A-10 - Complaint System.
Section 27-21A-11 - Investments.
Section 27-21A-12 - Protection Against Insolvency.
Section 27-21A-13 - Prohibited Practices.
Section 27-21A-14 - Regulation of Producers.
Section 27-21A-15 - Powers of Insurers and Health Care Service Plans.
Section 27-21A-16 - Examination.
Section 27-21A-17 - Suspension or Revocation of Certificate of Authority.
Section 27-21A-19 - Regulations.
Section 27-21A-20 - Administrative Procedures.
Section 27-21A-22 - Penalties and Enforcement.
Section 27-21A-23 - Statutory Construction and Relationship to Other Laws.
Section 27-21A-24 - Filings and Reports as Public Documents.
Section 27-21A-25 - Confidentiality of Medical Information.
Section 27-21A-26 - State Health Officer's and Commissioner's Authority to Contract.
Section 27-21A-27 - Acquisition of Control of or Merger of a Health Maintenance Organization.
Section 27-21A-29 - Existing Health Maintenance Organizations.
Section 27-21A-30 - Coordination of Benefits.
Section 27-21A-31 - Health Maintenance Organization Advisory Council.