Vermont Statutes Title 8 Sec. 5109
Terms Used In Vermont Statutes Title 8 Sec. 5109
- Commissioner: means the Commissioner of Financial Regulation. See
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- following: when used by way of reference to a section of the law shall mean the next preceding or following section. See
- Health maintenance organization: means any person who furnishes, either directly or through arrangements with others, comprehensive health care services to an enrolled member in return for periodic payments; the amounts of said payments are agreed upon prior to the time during which the health care services may be furnished; and who is obligated to the member to arrange for or to provide directly available and accessible health care services. See
§ 5109. Sanctions
Upon satisfactory evidence that any health maintenance organization has violated any law or regulation or in any way has failed in meeting its financial and contractual obligations to its members, including quality assurance as provided by 18 V.S.A. § 9414, the Commissioner may, in the Commissioner’s discretion, pursue any one or more of the following courses of action:
(1) Suspend the certificate of authority to operate as a health maintenance organization under this chapter. During the period of suspension, the organization shall not enroll any additional members except new employees of any employer whose employees are enrolled in the health maintenance organization by virtue of their employment, newborn children, or other newly acquired dependents of existing members and shall not engage in any advertising or solicitation whatever.
(2) Revoke the certificate of authority to operate as a health maintenance organization under this chapter. When the certificate of authority is revoked, the organization shall proceed under the supervision of the Commissioner, immediately following the effective date of the order of revocation, to wind up its affairs, and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization. It shall engage in no further advertising or solicitation whatsoever. The Commissioner may, by written order, permit such further operation of the organization as the Commissioner may find to be in the best interests of members to the end that members will be afforded the greatest practical opportunity to obtain continuing health care coverage.
(3) Impose an administrative penalty of not more than $5,000.00 for each and every unlawful act committed; each violation shall constitute a separate fineable offense.
(4) Issue an administrative order requiring the health maintenance organization: to cease or modify inappropriate conduct or practices by it or any of the personnel employed or associated with it; to fulfill its contractual and financial obligations to its members.
(5) When the Commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist or that grounds for the suspension or revocation of a certificate of authority exist, the Commissioner shall notify the health maintenance organization in writing specifically stating the grounds for denial, suspension, or revocation and fixing a time of at least 30 days thereafter for a hearing on the matter. (Added 1979, No. 117 (Adj. Sess.); amended 1993, No. 30, § 12, eff. May 21, 1993; 1995, No. 167 (Adj. Sess.), § 23; 2021, No. 105 (Adj. Sess.), § 242, eff. July 1, 2022.)