South Carolina Code of Laws
Chapter 33 - Health Maintenance Organizations
Section 38-33-180. Suspension or revocation of certificate of authority.

(A) The director or his designee may suspend or revoke a certificate of authority issued to a health maintenance organization if he finds that one or more of the following conditions exist:
(1) The health maintenance organization is operating significantly in contravention of its basic organizational document or in a manner contrary to that described in other information submitted under Section 38-33-30, unless amendments to the submissions have been filed with and approved by the director or his designee.
(2) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of Section 38-33-80.
(3) The health maintenance organization does not provide or arrange for basic health care services.
(4) The health maintenance organization does not meet the requirements of Section 38-33-40 or is unable to fulfill its obligations to furnish health care services.
(5) The health maintenance organization is financially unsound or reasonably may be expected to be unable to meet its obligations to enrollees or prospective enrollees.
(6) The health maintenance organization has failed to implement a mechanism affording the enrollees an opportunity to participate in matters of policy and operation under Section 38-33-60.
(7) The health maintenance organization has failed to implement the complaint system required by Section 38-33-110 in a reasonable manner to resolve valid complaints.
(8) The health maintenance organization, or a person on its behalf, advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner.
(9) The continued operation of the health maintenance organization is hazardous to its enrollees.
(10) The health maintenance organization otherwise has failed to comply with this chapter or regulations promulgated under it by the department.
(B) A certificate of authority is suspended or revoked only after compliance with the requirements of Section 38-33-210.
(C) When the certificate of authority of a health maintenance organization is suspended, the health maintenance organization, during the suspension, may not enroll additional enrollees except newborn children or other newly acquired dependents of existing enrollees and may not engage in advertising or solicitation.
(D) When the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and may conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization. It may not engage in further advertising or solicitation. The director or his designee, by written order, may permit further operation of the organization he finds to be in the best interest of enrollees, to the end that enrollees are afforded the greatest practical opportunity to obtain continuing health care coverage.
HISTORY: Enacted as 1976 Code Section 38-25-180 by 1987 Act No. 83, Section 1; recodified as Section 38-33-180 by 1987 Act No. 155, Section 24; 1992 Act No. 403, Section 6; 1993 Act No. 181, Section 633.

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.