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Session Laws, 1989
Volume 771, Page 5018   View pdf image
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VETOES

WHO CONVERTED THEIR GROUP COVERAGE INTO INDIVIDUAL CONVERSION
COVERAGE SHALL BE OFFERED THE SAME CONVERSION COVERAGE THAT IS
OFFERED BY THE SUCCESSOR HEALTH MAINTENANCE ORGANIZATION TO
PERSONS CONVERTING FROM THE GROUP OF WHICH THE ENROLLEE OR
SUBSCRIBER HAD BEEN A FORMER MEMBER;

(5)  (I) EQUITABLY ALLOCATE THE INSOLVENT HEALTH
MAINTENANCE ORGANIZATION'S NONGROUP INDIVIDUAL CONTRACTS OF THOSE
NONGROUP INDIVIDUALS NOT OFFERED OTHER COVERAGE UNDER PARAGRAPH
(3) OF THIS SUBSECTION, AMONG ALL HEALTH MAINTENANCE
ORGANIZATIONS OPERATING WITHIN A PORTION OF THE INSOLVENT HEALTH
MAINTENANCE ORGANIZATION'S SERVICE AREA;

(II)  BEFORE ALLOCATING THE NONGROUP INDIVIDUAL
CONTRACT OR CONTRACTS UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH,
THE COMMISSIONER SHALL CONSIDER THE HEALTH CARE DELIVERY SYSTEM
AND FINANCIAL RESOURCES OF ALL POSSIBLE SUCCESSOR HEALTH
MAINTENANCE ORGANIZATIONS.;

(III)  EACH HEALTH MAINTENANCE ORGANIZATION
ALLOCATED A NONGROUP INDIVIDUAL OR INDIVIDUALS UNDER ITEM (I) OF
THIS PARAGRAPH SHALL OFFER THE NONGROUP INDIVIDUAL OR INDIVIDUALS
THE HEALTH MAINTENANCE ORGANIZATION'S EXISTING COVERAGE WHICH IS
MOST SIMILAR TO THE NONGROUP INDIVIDUAL'S COVERAGE WITH THE
INSOLVENT HEALTH MAINTENANCE ORGANIZATION AT RATES DETERMINED IN
ACCORDANCE WITH THE SUCCESSOR HEALTH MAINTENANCE ORGANIZATION'S
EXISTING RATE METHODOLOGY; AND

(6)  TAKE ANY OTHER ACTION DEEMED NECESSARY BY THE
COMMISSIONER.

(F) THE CLAIMS AND EXPENSES OF HEALTH CARE PROVIDERS
INCURRED BY THE COMMISSIONER, AS A RECEIVER, IN CONTINUING PLAN
BENEFITS AS PROVIDED IN THE INSOLVENT HEALTH MAINTENANCE
ORGANIZATION'S PLAN OF INSOLVENCY ADOPTED UNDER § 19-710(O) OF
THIS SUBTITLE SHALL:

(1)  BE CONSIDERED EXPENSES FOR THE ADMINISTRATION OF
THE RECEIVERSHIP; AND

(2)  HAVE PRIORITY OVER ALL OTHER EXPENSES.

[(d)] (G) In the event of the liquidation or rehabilitation
of a health maintenance organization under this section, members
of the health maintenance organization shall have the same
priority of claims as provided in Article 48A, § 158A of the
Code.

[(e)] (H) (1) A health care provider may not assert a claim
of subrogation against:

- 5018 -

 

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Session Laws, 1989
Volume 771, Page 5018   View pdf image
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