Sec. 11. (a) Before making any material modification of any matter or document furnished under section 8 of this chapter, a limited service health maintenance organization shall file with the commissioner:
(1) a notice of the modification; and
(2) supporting documents that are necessary to fully explain the modification.
(b) If a limited service health maintenance organization desires to add one (1) or more limited health services, it must:
(1) file a notice with the commissioner;
(2) submit the information required by section 8 of this chapter concerning each limited health service to be added, if that information is different from the information filed with the application of the limited service health maintenance organization; and
(3) demonstrate compliance with sections 16, 17, 18, and 23 of this chapter with respect to each limited health service to be added by the organization.
(c) If the commissioner does not disapprove a filing under subsection (a) or (b) within thirty (30) days after the commissioner receives the filing, or within any period of extension granted by the commissioner, the filing shall be deemed approved.
(d) If a filing under subsection (a) or (b) is disapproved, the commissioner shall:
(1) notify the limited service health maintenance organization of the disapproval of the filing in writing deposited in the United States mail addressed to the limited service health maintenance organization; and
(2) specify the reasons for disapproval of the filing in the notice.
(e) Within thirty (30) days after it receives a notice of disapproval under subsection (d), the limited service health maintenance organization may request a hearing before the commissioner under IC 4-21.5 concerning the disapproval of the filing. If, not more than thirty (30) days after receiving the notice from the commissioner, the limited service health maintenance organization requests a hearing, the commissioner shall hold a hearing upon not less than ten (10) days notice to the limited service health maintenance organization.
As added by P.L.26-1994, SEC.25.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 34. Limited Service Health Maintenance Organizations
27-13-34-0.1. Application of Certain Amendments to Chapter
27-13-34-1. "Enrollee" Defined
27-13-34-2. "Evidence of Coverage" Defined
27-13-34-3. "Limited Health Services" Defined
27-13-34-4. "Limited Service Health Maintenance Organization" Defined
27-13-34-5. "Provider" Defined
27-13-34-6. "Subscriber" Defined
27-13-34-7. Certificate of Authority Required; Foreign Entities
27-13-34-8. Application for Certificate of Authority; Requirements
27-13-34-9. Issuance of Certificate of Authority; Application Deficiencies; Denial of Application
27-13-34-10. Powers of Limited Service Health Maintenance Organization
27-13-34-11. Modification of Documents; Filing; Disapproval
27-13-34-12. Applicable Statutes
27-13-34-13. Evidence of Coverage; Required Information
27-13-34-14. Examinations by Commissioner
27-13-34-15. Required Contract Terms and Conditions; Exemptions
27-13-34-18. Fidelity Bonds; Deposit in Place of Bond
27-13-34-19. Annual Reports; Additional Reports
27-13-34-20. Suspension or Revocation of Certificate of Authority
27-13-34-21. Chapter Violations; Fines and Penalties
27-13-34-22. Supervision, Rehabilitation, or Liquidation; Remedies and Measures
27-13-34-24. Dental Care Services and Director; Review of Adverse Decisions; Complaints