RSA 420-B:7 · Powers of Health Maintenance Organizations

420-B:7 Powers of Health Maintenance Organizations. – The powers of a holder of a certificate of authority issued pursuant to RSA 420-B:5 shall include, in addition to any powers conferred by the law under which the health maintenance organization is organized, and subject to all restrictions imposed in this chapter, or by the commissioner, the following:

Copy link

I.

The power to purchase, lease, construct, renovate, operate, or maintain medical clinics and their ancillary equipment as may reasonably be required for its principal office or for such other purposes as may be necessary in the transaction of the business of the health maintenance organization;

Copy link

II.

The power to furnish health care services on a prepaid basis through providers which are under contract with, otherwise associated with, retained by or employed by the health maintenance organization;

Copy link

III.

The power to render health care services on a basis other than prepaid, including charitable and fee for service, through providers which are under contract with, otherwise associated with, retained by, or employed by the health maintenance organization;

Copy link

IV.

The power to make loans to a medical group under contract with the health maintenance organization in furtherance of its program, or make loans to a corporation or corporations under its control for the purpose of acquiring or constructing medical clinics, or in furtherance of a program providing health care services to enrolled participants;

Copy link

V.

The power to enter into evidences of coverage to provide an agreed upon set of health care services to enrolled participants or groups of enrolled participants in exchange for a prepaid per capita, or prepaid aggregate, fixed sum;

Copy link

VI.

The power to market evidences of coverage, enroll enrolled participants and administer its program of marketing, or contract with any person for the performance, on behalf of the health maintenance organization, of such functions;

Copy link

VII.

The power to contract with an insurance company licensed in this state, or with a hospital medical service or health service corporation authorized to do business in this state, for the provisions of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization;

Copy link

VIII.

The power to offer, in addition to health care services, indemnity benefits covering out-of-area or emergency services; and

Copy link

IX.

The power to receive and accept from governmental or private agencies or any persons, payments or grants covering all or part of the cost of the services provided or arranged for by the health maintenance organization.

Copy link

X.

The power to offer out-of-plan covered services if those services are provided by a point-of-service product on an in-plan basis.

Copy link

XI.

The power to act as a health care insurer as defined in RSA 420-C:2, IV only when offering a Medicare Advantage plan in accordance with 42 U.S.C. sections 1395w-21 through1395w-29. Source. 1977, 282:1. 2002, 207:7, eff. May 16, 2002. 2020, 39:13, eff. July 29, 2020.

Copy link