58-67-30. Management and exclusive agreements; custodial agreements.
(a) No health maintenance organization shall enter into an exclusive agency, management, or custodial agreement unless the agreement is first filed with the Commissioner and approved under this section within 45 days after filing or such reasonable extended period as the Commissioner shall specify by notice that is given within the 45 day period.
(b) The Commissioner shall disapprove an agreement submitted under subsection (a) of this section if the Commissioner determines that the agreement:
(1) Subjects the health maintenance organization to excessive charges;
(2) Extends for an unreasonable period of time;
(3) Does not contain fair and adequate standards of performance;
(4) Enables persons under the contract to manage the health maintenance organization who are not sufficiently trustworthy, competent, experienced, and free from conflict of interest to manage the health maintenance organization with due regard for the interests of its enrollees, creditors, or the public; or
(5) Contains provisions that impair the interests of the organization's enrollees, creditors, or the public. (1987, c. 631, s. 10; 2001-223, s. 20.5.)
Structure North Carolina General Statutes
North Carolina General Statutes
Article 67 - Health Maintenance Organization Act.
§ 58-67-10 - Establishment of health maintenance organizations.
§ 58-67-11 - Additional HMO application information.
§ 58-67-12 - Commissioner use of consultants and other professionals.
§ 58-67-20 - Issuance and continuation of license.
§ 58-67-30 - Management and exclusive agreements; custodial agreements.
§ 58-67-35 - Powers of health maintenance organizations.
§ 58-67-45 - Fiduciary responsibilities.
§ 58-67-50 - Evidence of coverage and premiums for health care services.
§ 58-67-55 - Statements filed with Commissioner.
§ 58-67-65 - Prohibited practices.
§ 58-67-66 - Collaboration with local health departments.
§ 58-67-70 - Coverage for chemical dependency treatment.
§ 58-67-74 - Coverage for certain treatment of diabetes.
§ 58-67-75 - No discrimination against mentally ill or chemically dependent individuals.
§ 58-67-76 - Coverage for mammograms and cervical cancer screening.
§ 58-67-77 - Coverage for prostate-specific antigen (PSA) tests.
§ 58-67-78 - Coverage of certain prescribed drugs for cancer treatment.
§ 58-67-79 - Coverage for reconstructive breast surgery following mastectomy.
§ 58-67-80 - Meaning of terms "accident", "accidental injury", and "accidental means".
§ 58-67-85 - Master group contracts, filing requirement; required and prohibited provisions.
§ 58-67-88 - Continuity of care.
§ 58-67-90 - Licensing and regulation of agents.
§ 58-67-95 - Powers of insurers, hospitals, prepaid health plans, and medical service corporations.
§ 58-67-105 - Hazardous financial condition.
§ 58-67-110 - Protection against insolvency.
§ 58-67-115 - Hold harmless agreements or special deposit.
§ 58-67-120 - Continuation of benefits.
§ 58-67-125 - Enrollment period.
§ 58-67-130 - Replacement coverage.
§ 58-67-135 - Incurred but not reported claims.
§ 58-67-140 - Suspension or revocation of license.
§ 58-67-145 - Rehabilitation, liquidation, or conservation of health maintenance organization.
§ 58-67-155 - Administrative procedures.
§ 58-67-165 - Penalties and enforcement.
§ 58-67-170 - Statutory construction and relationship to other laws.
§ 58-67-171 - Other laws applicable to HMOs.
§ 58-67-175 - Filings and reports as public documents.