VETOES

(II) 2. (II) A HEALTH CARE PROVIDER OR ANY
REPRESENTATIVE OF A HEALTH CARE PROVIDER MAY NOT MAINTAIN ANY
ACTION AGAINST ANY SUBSCRIBER OR ENROLLEE TO COLLECT OR ATTEMPT
TO COLLECT ANY MONEY OWED BY THE HEALTH MAINTENANCE ORGANIZATION
TO THE HEALTH CARE PROVIDER.

(3) (III) (3) NOTWITHSTANDING ANY OTHER PROVISION OF
THIS SUBSECTION, A HEALTH CARE PROVIDER OR REPRESENTATIVE OF A
HEALTH CARE PROVIDER MAY COLLECT OR ATTEMPT TO COLLECT FROM A
SUBSCRIBER OR ENROLLEE:

(I)  ANY COPAYMENT OR COINSURANCE SUMS OWED BY
THE SUBSCRIBER OR ENROLLEE TO THE HEALTH MAINTENANCE ORGANIZATION
FOR COVERED SERVICES PROVIDED BY THE HEALTH CARE PROVIDER; OR

(II)  ANY PAYMENT OR CHARGES FOR SERVICES NOT
COVERED UNDER THE SUBSCRIBER'S CONTRACT.

(O) (P) (1) THE COMMISSIONER SHALL REQUIRE EACH HEALTH
MAINTENANCE ORGANIZATION TO HAVE AN INSOLVENCY PLAN BY JANUARY 1,
1990 WHICH PROVIDES FOR:

(I)  CONTINUATION OF BENEFITS TO SUBSCRIBERS AND
ENROLLEES FOR THE DURATION OF THE CONTRACT PERIOD FOR WHICH
PREMIUMS HAVE BEEN PAID; AND

(II)  CONTINUATION OF BENEFITS TO SUBSCRIBERS OR
ENROLLEES WHO ARE ADMITTED TO AN INPATIENT HEALTH CARE FACILITY
ON THE DATE OF INSOLVENCY UNTIL, THE EARLIER OF:

1.  THE SUBSCRIBER OR ENROLLEE IS
DISCHARGED FROM THE INPATIENT HEALTH CARE FACILITY; OR

2.  365 DAYS.

(2) IN DETERMINING THE ADEQUACY OF ANY INSOLVENCY
PLAN, THE COMMISSIONER MAY CONSIDER:

(I)  THE EXISTENCE OF INSURANCE TO COVER
EXPENSES INCURRED IN CONTINUING BENEFITS AFTER AN INSOLVENCY;

(II)  PROVISIONS IN PROVIDER CONTRACTS
OBLIGATING PROVIDERS TO CONTINUE TO PROVIDE SERVICES TO ENROLLEES
OR SUBSCRIBERS:

1.  FOR THE DURATION OF THE CONTRACT
PERIOD FOR WHICH PREMIUMS HAVE BEEN MADE; AND

2.  IF ADMITTED TO AN INPATIENT HEALTH
CARE FACILITY, UNTIL THE ENROLLEE OR SUBSCRIBER IS DISCHARGED OR
365 DAYS, WHICHEVER OCCURS FIRST;

- 5020 -