South Carolina Code of Laws
Chapter 33 - Health Maintenance Organizations
Section 38-33-90. Statements and reports.

(A) Every health maintenance organization annually shall file with the department by March first, in the form and detail the director or his designee prescribes, a statement showing the business standing and financial condition of the health maintenance organization on December thirty-first of the preceding year, except that upon timely written request by the president or chief executive officer setting forth reasons why the statement cannot be filed within the time provided, the director or his designee may grant in writing an extension of filing time for not more than thirty days. This statement must conform substantially to the statement form adopted by the National Association of Insurance Commissioners. Unless the director or his designee provides otherwise, the annual statement is to be prepared in accordance with the annual statement instructions and the Accounting Practices and Procedures Manual adopted by the National Association of Insurance Commissioners.
(B) The director or his designee may require every health maintenance organization to file quarterly reports and additional information considered necessary to enable the director or his designee to carry out his duties under this chapter. The reports and information must be furnished in the time and manner prescribed by the director or his designee.
(C) Every health maintenance organization which is authorized to write business in this State shall file annually with the National Association of Insurance Commissioners by March first a copy of its annual statement convention blank along with any additional filings prescribed by the director or his designee for the preceding year. The information filed with the National Association of Insurance Commissioners must be in the same format and scope as that required by the director or his designee and must include the signed jurat page and the actuarial certification. Any amendments and addenda to the annual statement filing subsequently filed with the director or his designee also must be filed with the National Association of Insurance Commissioners. Foreign health maintenance organizations domiciled in a state which has a law substantially similar to this subsection are considered in compliance with this section.
(D) In the absence of actual malice, members of the National Association of Insurance Commissioners, their authorized committees, subcommittees, and task forces, their delegates, National Association of Insurance Commissioners' employees, and all others charged with the responsibility of collecting, reviewing, analyzing, and disseminating the information developed from the filing of the annual statement convention blanks are acting as agents of the director or his designee under the authority of this section and are not subject to civil liability for libel, slander, or any other cause of action by virtue of their collection, review, and analysis or dissemination of the data and information collected from the filings required by this section.
HISTORY: Enacted as 1976 Code Section 38-25-90 by 1987 Act No. 83, Section 1; recodified as Section 38-33-90 by 1987 Act No. 155, Section 24; 1992 Act No. 403, Section 3; 1993 Act No. 181, Section 633; 2000 Act No. 312, Section 7.

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.