Evidence of the existence of insurance or a plan for
self-insurance approved by the Commissioner must be submitted at least 30 days
prior to the expiration date of the policy and with each annual report.
Unless the Commissioner grants an exemption from requirements
of this section, the HMO shall secure insurance coverage or furnish evidence of
acceptable self-insurance to provide:
(1) For payments or services required to be
made or furnished under the health care contract to those enrollees who are
injured or become ill outside the geographical limits served by the
HMO;
(2) Reinsurance protection to
the HMO in the event of catastrophic or unusual losses in excess of levels of
loss which the HMO assumes in the basis of its calculation of premium charges
(schedule of charges);
(3) That the
HMO has an agreement with an Alabama licensed insurer or nonprofit health
service plan under which the insurer or nonprofit health service plan agrees to
issue to enrollees in the HMO, a plan of hospital, medical and surgical
insurance at standard conversion premium rates without any underwriting or
other requirement, other than an application and payment of the first monthly
premium by the enrollee, in the event the HMO is unable to continue in
operation;
(4) For a general
liability and medical malpractice plan or an adequate plan for self-insurance
program approved by the Commissioner. Evidence of these plans must be submitted
at least 30 days prior to the expiration date of the policy and with each
annual report.
Author: Commissioner of Insurance
Notes
Ala. Admin. Code
r. 482-1-079-.14
New Rule: Filed April 22,
1987; effective May 8, 1987. Filed for codification in the Alabama
Administrative Code by the Department of Insurance on April 23, 2004, pursuant
to the Code of Ala. 1975, § 27-7-43.
Statutory Authority:
Code of Ala.
1975, §§
27-2-17,
27-21A-19.
