Nev. Admin. Code § 695C.130 - Health maintenance organization: Financial requirements; modification to approved plan of operations
1. Except as
otherwise provided in this section, a health maintenance organization which
receives a certificate of authority shall maintain and report on its financial
statement filed with the Commissioner pursuant to
NRS
695C.210 a minimum net worth in an amount
which is the greater of:
(a) One million five
hundred thousand dollars;
(b) Two
percent of the first $150,000,000 earned as revenue from premiums collected in
the preceding 12-month period, plus 1 percent of the amount in excess of
$150,000,000 earned as revenue from premiums collected in the preceding
12-month period; or
(c) The amount
of risk-based capital determined in the manner set forth in
NRS
681B.550 and the regulations adopted pursuant
thereto.
2. In addition
to the requirements set forth in subsection 1, a health maintenance
organization which receives a certificate of authority shall maintain:
(a) A separate surety bond or deposit of not
less than $250,000 of cash or securities for the protection of enrollees of
this State;
(b) Blanket fidelity
coverage issued by an authorized insurer as required by NAC
695C.120 for new health
maintenance organizations; and
(c)
The operating and insolvency reserves required for new health maintenance
organizations.
3. In
addition to the requirements set forth in subsections 1 and 2, a domestic
health maintenance organization which receives a certificate of authority shall
maintain a portion of not less than $500,000 of the required minimum net worth
in the form of a deposit of cash or securities eligible for deposit under
NRS
682B.030 for the sole benefit and protection
of enrollees of this State.
4. If
the Commissioner determines that the financial condition of a health
maintenance organization fails to comply with the conditions set forth in
NRS
695C.090, he or she may require the
organization to:
(a) Maintain a net worth that
is greater than the amount required by subsection 1;
(b) Obtain a written guarantee from a
business which has sufficient surplus and an adequate history of generating net
income to guarantee the maintenance of the minimum net worth of the health
maintenance organization required by subsection 1 and obtain approval of the
written guarantee and guarantor from the Commissioner; or
(c) Comply with paragraphs (a) and
(b).
5. If a health
maintenance organization proposes to make a material modification to its
approved plan of operations, it shall submit a copy of its proposed
modification to the Commissioner. The Commissioner may, as a condition of
approval for the proposed modification by the health maintenance organization,
require the health maintenance organization to increase the amount of reserves,
deposits, bonds or minimum net worth it is required to maintain. The
Commissioner may, in making such a determination, consider the conditions set
forth in NRS
695C.090.
Notes
NRS 679B.130
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