South Carolina Code of Laws
Chapter 33 - Health Maintenance Organizations
Section 38-33-130. Security deposit; individual stop-loss coverage; provisions for unpaid claim liability; individual conversion policy.

(A) Each health maintenance organization shall deposit and maintain with the department cash or securities which qualify as legal investments under the laws of this State for public sinking funds in the amount of three hundred thousand dollars. The director or his designee may require a health maintenance organization to make deposits in excess of the amount specified in this section if in his opinion the additional deposits are necessary for the protection of enrollees and the public. All income from deposits must belong to the depositing organization and must be paid to it as it becomes available. A health maintenance organization that has made a security deposit may withdraw that deposit or part of it after making a substitute deposit of cash, securities, or a combination of these of equal amount and value. Securities must be approved by the director or his designee before being substituted. The return of cash or securities deposited with the department by a health maintenance organization pursuant to this section is governed by Section 38-9-150.
(B) Each health maintenance organization shall require every provider who participates in the health maintenance organization and furnishes health care services to the health maintenance organization's enrollees to execute an agreement not to bill the enrollees or otherwise hold the enrollees financially responsible for services rendered. Provided, an employing entity may execute one agreement on behalf of the employing entity and all of its providers. An employing entity may also execute one participation agreement and one of other similar required forms on behalf of the employing entity and all of its providers. The provider's agreement must be given on forms prescribed or approved by the director or his designee, shall extend to all services furnished to the enrollee during the time he was enrolled in the health maintenance organization, and shall apply even where the provider or employing entity had not been paid by the health maintenance organization.
(C) A health maintenance organization shall procure and maintain a policy of individual excess stop-loss coverage provided by an insurance company licensed by the State. The policy also must include provisions to cover all incurred, unpaid claim liability in the event of the termination of the health maintenance organization due to insolvency or otherwise. In addition, the director or his designee may require that the policy provide that the insurer will issue an individual policy to an enrollee upon termination of the health maintenance organization or the ineligibility of the enrollee for further coverage in the health maintenance organization.
HISTORY: Enacted as 1976 Code Section 38-25-130 by 1987 Act No. 83, Section 1; recodified as Section 38-33-130 by 1987 Act No. 155, Section 24; 1988 Act No. 622, Section 3; 1992 Act No. 280, Section 3; 1993 Act No. 181, Section 633; 1999 Act No. 98, Section 4; 2012 Act No. 137, Section 6, eff April 2, 2012.

Structure South Carolina Code of Laws

South Carolina Code of Laws

Title 38 - Insurance

Chapter 33 - Health Maintenance Organizations

Section 38-33-10. Short title.

Section 38-33-20. Definitions.

Section 38-33-30. Necessity of certificate of authority; foreign corporation.

Section 38-33-40. Issuance of certificate of authority; criteria and considerations; arrangements for participation of providers in each geographic area served.

Section 38-33-50. Powers of health maintenance organization; notice prior to exercise of powers.

Section 38-33-60. Members of governing body; advisory panels, etc.

Section 38-33-70. Fiduciary relationship in handling of funds.

Section 38-33-80. Enrollee entitled to evidence of coverage; contents of evidence of coverage; discontinuance or replacement of coverage; charges for services.

Section 38-33-90. Statements and reports.

Section 38-33-100. Financial requirements before issuance of certificate of authority to health maintenance organization.

Section 38-33-110. Complaint procedures; reports; malpractice claims; applicability of Freedom of Information Act.

Section 38-33-120. Investment of funds.

Section 38-33-130. Security deposit; individual stop-loss coverage; provisions for unpaid claim liability; individual conversion policy.

Section 38-33-140. Advertisements; application of provisions relating to trade practices; use of term "insurer" or "health maintenance organization".

Section 38-33-150. Agent for organization; exemption from licensing requirements.

Section 38-33-160. Operation of health maintenance organization by insurance company; contracts for cost of care.

Section 38-33-170. Examination of affairs of organization; quality of health care services; books and records; expense of examination; reports.

Section 38-33-180. Suspension or revocation of certificate of authority.

Section 38-33-190. Rehabilitation, liquidation, or conservation of a health maintenance organization; priorities.

Section 38-33-200. Implementation of regulations.

Section 38-33-210. Notification of grounds for denial, suspension or revocation of certificate of authority; hearings; judicial review.

Section 38-33-220. Fees.

Section 38-33-230. Levy of administrative penalty in lieu of revocation or suspension of certificate of authority; monetary penalty; notice and hearings; injunctions.

Section 38-33-240. Application of provisions of insurance law or law relating to solicitation or advertising by health professionals; practice of medicine, dentistry or other healing profession.

Section 38-33-250. Records of organization as public documents; trade secrets, etc.

Section 38-33-260. Confidentiality of health records.

Section 38-33-270. Contractual powers of Department to assist in investigative duties; assessments for consulting expenses.

Section 38-33-280. Acquisition or exchange of securities of a health maintenance organization; merger or consolidation of HMO.

Section 38-33-290. Participation by physician, podiatrist, optometrist, or oral surgeon as provided in HMO.

Section 38-33-300. Liability for participation in quality of care or utilization review.

Section 38-33-310. HMO may contract with out-of-state provider.

Section 38-33-325. Obstetrician-gynecologist services; referrals; authorization for services; member notification of plan provisions.