Vermont Statutes Title 8 Sec. 5105
Terms Used In Vermont Statutes Title 8 Sec. 5105
- Commissioner: means the Commissioner of Financial Regulation. 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
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Person: includes individuals, partnerships, associations, trusts, and corporations. See
- State: when applied to the different parts of the United States may apply to the District of Columbia and any territory and the Commonwealth of Puerto Rico. See
§ 5105. Examinations
(a) The Commissioner shall make an examination of the affairs of any health maintenance organization organized or holding a certificate of authority as a health maintenance organization in this State as often as the Commissioner deems it necessary, but not less frequently than once in every three years to ensure that the financial and contractual obligations of the health maintenance organization are being met in accordance with Vermont law. The Commissioner may enlarge this three-year period to five years, provided the health maintenance organization is subject to a comprehensive annual audit during such period of a scope satisfactory to the Commissioner, by independent auditors approved by the Commissioner. The Commissioner shall examine a health maintenance organization that is organized in another state as if it were organized in this State. In lieu of such examination, the Commissioner may accept an examination report on the company as prepared by the insurance department of the company’s state of domicile. Prior to accepting an examination report from any foreign jurisdiction, the Commissioner shall determine that the examination was performed in a manner and using methods and criteria that are as stringent as those established for Vermont examinations. Nothing in this section shall restrict the Commissioner’s power to examine a health maintenance organization when the Commissioner deems it to be in the best interests of members or policyholders.
(b) All financial and market conduct examinations shall be conducted pursuant to and in conformity with sections 3573, 3574, 3575, and 3576 of this title at the expense of the health maintenance organization and shall be conducted in accordance with guidelines, principles, manuals, instructions, and other procedures promulgated by the National Association of Insurance Commissioners, including the use of statutory accounting principles for financial examinations, together with any useful or necessary modifications or adaptation thereof required or approved by the Commissioner. Every health maintenance organization shall provide the Commissioner with all books and records relating to its operation, including books and records of any affiliate or subsidiary as defined in section 3681 of this title. For the purpose of examinations, the Commissioner may issue subpoenas, administer oaths to, and examine any person and the officers and agents of the health maintenance organization. (Added 1979, No. 117 (Adj. Sess.); amended 1993, No. 30, § 9, eff. May 21, 1993; 1999, No. 38, § 3, eff. May 20, 1999; 2009, No. 42, § 12; 2021, No. 105 (Adj. Sess.), § 240, eff. July 1, 2022.)