Montana Code 33-30-105. Examination of health service corporation
33-30-105. Examination of health service corporation. (1) If the commissioner believes a health service corporation is unable or potentially unable to fulfill its contractual obligations to its members, the commissioner may conduct an examination of that corporation.
Terms Used In Montana Code 33-30-105
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Health service corporation: means a nonprofit corporation organized or operating for the purposes of establishing and operating a nonprofit plan or plans under which prepaid hospital care, medical-surgical care, and other health care and services, or reimbursement for the preceding care and services, may be furnished to a member or beneficiary. See Montana Code 33-30-101
- Testimony: Evidence presented orally by witnesses during trials or before grand juries.
- Writing: includes printing. See Montana Code 1-1-203
(2)In addition to the examination authorized in subsection (1), at least once every 4 years, the commissioner shall conduct an examination of each health service corporation to determine if the corporation is fulfilling its contractual obligations by prompt satisfaction of claims at the highest monetary level consistent with reasonable dues or fees and that the corporation’s management exercises appropriate fiscal controls, operations, and personnel policies to ensure that efficient and economic administration restrains overhead costs for the benefit of its members.
(3)Each health service corporation examined and its officers, employees, and insurance producers shall produce and make available to the commissioner or the commissioner’s examiners the accounts, records, documents, files, information, assets, and matters in its possession or control relating to the subject of the examination.
(4)The commissioner or the commissioner’s examiner shall make a verified report of the examination.
(5)The report must comprise only facts appearing from the books, papers, records, or documents of the corporation examined or ascertained from the testimony, under oath, of individuals concerning its affairs and conclusions and recommendations as warranted by those facts.
(6)The commissioner shall furnish a copy of the proposed report to the corporation examined not less than 20 days prior to its filing in the commissioner’s office. If the corporation requests a hearing, in writing, within the 20-day period, the commissioner shall grant a hearing with respect to the report and may not file the report until after the hearing and after modifications, if any, that the commissioner considers proper.
(7)The health service corporation shall pay for each examination conducted pursuant to subsections (1) and (2) in accordance with 33-1-413.