reglab/housing_qa huggingface dataset:
8 V.S.A. § 5104
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5104. Filing and approval of rates and forms; supplemental orders

§ 5104. Filing and approval of rates and forms; supplemental orders|(a)(1) A health maintenance organization which has received a certificate of authority under section 5102 of this title shall file and obtain approval of all policy forms and rates as provided in sections 4062 and 4062a of this title. This requirement shall include the filing of administrative retentions for any business in which the organization acts as a third party administrator or in any other administrative processing capacity. The Commissioner or the Green Mountain Care Board, as appropriate, may request and shall receive any information that the Commissioner or the Board deems necessary to evaluate the filing. In addition to any other information requested, the Commissioner or the Board shall require the filing of information on costs for providing services to the organization's Vermont members affected by the policy form or rate, including Vermont claims experience, and administrative and overhead costs allocated to the service of Vermont members. Prior to approval, there shall be a public comment period pursuant to section 4062 of this title. A health maintenance organization shall file a summary of rate filings pursuant to section 4062 of this title.  (2) The Commissioner or the Board shall refuse to approve the form of evidence of coverage, filing, or rate if it contains any provision which is unjust, unfair, inequitable, misleading, or contrary to the law of the State or plan of operation, or if the rates are excessive, inadequate or unfairly discriminatory, fail to protect the organization's solvency, or fail to meet the standards of affordability, promotion of quality care, and promotion of access pursuant to section 4062 of this title. No evidence of coverage shall be offered to any potential member unless the person making the offer has first been licensed as an insurance agent in accordance with chapter 131 of this title.   (b) In connection with a rate decision, the Board may also make reasonable supplemental orders and may attach reasonable conditions and limitations to such orders as the Board finds, on the basis of competent and substantial evidence, necessary to ensure that benefits and services are provided at reasonable cost under efficient and economical management of the organization. The Commissioner and, except as otherwise provided by 18 V.S.A. §§ 9375 and 9376, the Green Mountain Care Board, shall not set the rate of payment or reimbursement made by the organization to any physician, hospital, or health care provider. (Added 1979, No. 117 (Adj. Sess.); amended 1991, No. 166 (Adj. Sess.), § 15; 1993, No. 30, § 8, eff. May 21, 1993; 1993, No. 235 (Adj. Sess.), § 10b; 2011, No. 48, § 15d, eff. Jan. 1, 2012; 2011, No. 171 (Adj. Sess.), § 25a, eff. May 16, 2012; 2013, No. 79, § 5k, eff. Jan. 1, 2014.)
8 V.S.A. § 5105
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5105. Examinations

§ 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 assure that the financial and contractual obligations of the health maintenance organization are being met in accordance with Vermont law. The Commissioner may enlarge the aforesaid 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.)
8 V.S.A. § 5106
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5106. Annual report to the Commissioner

§ 5106. Annual report to the Commissioner|(a) Every organization subject to this chapter, annually, within 90 days of the close of its fiscal year, shall file a report with the Commissioner, said report verified by an appropriate official of the organization, showing its financial condition on the last day of the preceding fiscal year. The report shall be prepared in accordance with the National Association of Insurance Commissioners' Accounting Practices and Procedures Manual for health maintenance organizations and shall be in such general form and context, as approved by, and shall contain any other information required by the National Association of Insurance Commissioners together with any useful or necessary modifications or adaptations thereof required, approved, or accepted by the Commissioner for the type of organization to be reported upon, and as supplemented by additional information required by the Commissioner.(b) A health maintenance organization shall, when determining liabilities, include an amount estimated in the aggregate to provide for any unearned premium and for the payment of all claims for health care expenditures which have been incurred, whether reported or unreported, which are unpaid and for which such organization is or may be liable, and to provide for the expense of adjustment or settlement of such claims. (Added 1979, No. 117 (Adj. Sess.); amended 1993, No. 30, § 10, eff. May 21, 1993; 2011, No. 171 (Adj. Sess.), § 29, eff. May 16, 2012.)
8 V.S.A. § 5108
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5108. Prohibited practices

§ 5108. Prohibited practices|Section 4724 of this title relating to unfair trade practices shall be construed to apply to health maintenance organizations, except to the extent that the Commissioner determines that the nature of health maintenance organizations renders such section clearly inappropriate. (Added 1979, No. 117 (Adj. Sess.).)
8 V.S.A. § 5109
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5109. Sanctions

§ 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 his or her 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, such 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 such 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 he or she may find to be in the best interest 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.)
8 V.S.A. § 5110
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5110. Name of health maintenance organization

§ 5110. Name of health maintenance organization|No health maintenance organization, unless licensed as an insurer, may use in its name, evidences of coverage, contracts, or literature, any of the words "insurance," "casualty," "surety," "mutual," or any other words descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this State. (Added 1979, No. 117 (Adj. Sess.).)
8 V.S.A. § 5111
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5111. Rules

§ 5111. Rules|The Commissioner may, after notice and hearing, adopt reasonable rules under 3 V.S.A. chapter 25, as are necessary or proper to carry out the provisions of this chapter. (Added 1979, No. 117 (Adj. Sess.); amended 2015, No. 23, § 86.)
8 V.S.A. § 5112
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5112. Statutory construction and relationship to other laws

§ 5112. Statutory construction and relationship to other laws|Except as provided in this chapter, and except as provided in sections 3315, 4080a, 4080b, and 4080f, and subchapter 2 of chapter 112 of this title, provisions of the insurance laws and specifically provisions of chapters 123 and 125 of this title shall not be applicable to any health maintenance organization granted a certificate of authority under this chapter. (Added 1979, No. 117 (Adj. Sess.); amended 1991, No. 52, § 5, eff. June 6, 1991; 1991, No. 160 (Adj. Sess.), § 44, eff. May 11, 1992; 1993, No. 30, § 13, eff. May 21, 1993; 2001, No. 71, § 10a, eff. June 16, 2001; 2005, No. 191 (Adj. Sess.), § 19.)
8 V.S.A. § 5113
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5113. Severability

§ 5113. Severability|If any section, term, or provision of this chapter shall be adjudged invalid for any reason, such judgment shall not affect, impair, or invalidate any other section, term, or provision of this chapter, but the remaining section, terms, and provisions shall be and remain in full force and effect. (Added 1979, No. 117 (Adj. Sess.).)
8 V.S.A. § 5114
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5114. Part-time employees

§ 5114. Part-time employees|A health maintenance organization shall not exclude part-time employees or refuse to offer the same benefits to part-time employees as it offers to the employee groups of which the part-time employees would be members if they were full-time employees. The insurer shall offer to include the part-time employees as part of the employer's employee group, at the full rate to be paid by the employer, at a rate prorated between the employer and the employee or at the employee's expense. "Part-time employee" means any employee who works a minimum of at least 17 1/2 hours per week. (Added 1989, No. 34, § 4.)
8 V.S.A. § 5115
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 139 - Health Maintenance Organization|§ 5115. Duty of nonprofit health maintenance organizations

§ 5115. Duty of nonprofit health maintenance organizations|Any nonprofit health maintenance organization subject to this chapter shall offer nongroup plans to individuals in accordance with section 4080b of this title without discrimination based on age, gender, industry, and medical history, except as allowed by subdivisions 4080a(h)(2)(B) and 4080b(h)(2)(B) of this title. (Added 1991, No. 160 (Adj. Sess.), § 45, eff. July 1, 1993; amended 2005, No. 191 (Adj. Sess.), § 54.)
8 V.S.A. § 6003
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 141 - Captive Insurance Companies|§ 6003. Names of companies

§ 6003. Names of companies|No captive insurance company shall adopt a name that is the same, deceptively similar, or likely to be confused with or mistaken for any other existing business name registered in the State of Vermont. (Added 1981, No. 28.)
8 V.S.A. § 6004
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 141 - Captive Insurance Companies|§ 6004. Minimum capital and surplus; letter of credit

§ 6004. Minimum capital and surplus; letter of credit|(a) Prior to issuing any policies of insurance or entering into any contracts of reinsurance, each captive insurance company shall possess and thereafter maintain unimpaired paid-in capital and surplus of:  (1) in the case of a pure captive insurance company, not less than $250,000.00; (2) in the case of an association captive insurance company, not less than $500,000.00; (3) in the case of an industrial insured captive insurance company, not less than $500,000.00; (4) in the case of an agency captive insurance company, not less than $500,000.00; (5) in the case of a risk retention group, not less than $1,000,000.00; and (6) in the case of a sponsored captive insurance company, not less than $100,000.00.   (b) The Commissioner may prescribe additional capital and surplus based upon the type, volume, and nature of insurance business transacted.(c) Capital and surplus may be in the form of cash, marketable securities, a trust approved by the Commissioner and of which the Commissioner is the sole beneficiary, or an irrevocable letter of credit issued by a bank approved by the Commissioner. The Commissioner may reduce or waive the capital and surplus amounts required by this section pursuant to a plan of dissolution for the company approved by the Commissioner.(d) Within 30 days after commencing business, each captive insurance company shall file with the Commissioner a statement under oath of its president and secretary certifying that the captive insurance company possessed the requisite unimpaired paid-in capital and surplus prior to commencing business. (Added 1981, No. 28; amended 1993, No. 40, § 3, eff. June 3, 1993; 1993, No. 235 (Adj. Sess.), § 9d; 1999, No. 38, § 6, eff. May 20, 1999; 2003, No. 55, § 7; 2007, No. 178 (Adj. Sess.), § 5; 2009, No. 137 (Adj. Sess.), § 18, eff. May 29, 2010; 2011, No. 78 (Adj. Sess.), § 37, eff. April 2, 2012; 2015, No. 20, § 2, eff. May 7, 2015; 2017, No. 12, § 5, eff. May 1, 2017; 2019, No. 110 (Adj. Sess.), § 3, eff. June 15, 2020; 2021, No. 25, § 22, eff. May 12, 2021.)
8 V.S.A. § 6005
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 141 - Captive Insurance Companies|§ 6005. Dividends

§ 6005. Dividends|No captive insurance company may pay a dividend out of, or other distribution with respect to, capital or surplus without the prior approval of the Commissioner. Approval of an ongoing plan for the payment of dividends or other distributions shall be conditioned upon the retention, at the time of each payment, of capital or surplus in excess of amounts specified by, or determined in accordance with formulas approved by, the Commissioner. Notwithstanding the provisions of 11B V.S.A. chapter 13, a captive insurance company or incorporated protected cell organized under the provisions of Title 11B may make such distributions as are in conformity with its purposes and approved by the Commissioner. (Added 1981, No. 28; amended 1993, No. 40, § 4, eff. June 3, 1993; 1993, No. 235 (Adj. Sess.), § 9e; 1997, No. 49, § 10, eff. June 26, 1997; 1999, No. 38, § 7, eff. May 20, 1999; 2003, No. 55, § 7; 2019, No. 3, § 1, eff. April 18, 2019.)
8 V.S.A. § 6008
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 141 - Captive Insurance Companies|§ 6008. Examinations and investigations

§ 6008. Examinations and investigations|(a) Whenever the Commissioner determines it to be prudent, but not less frequently than once every five years, the Commissioner shall personally, or by some competent person appointed by the Commissioner, inspect and examine each captive insurance company to ascertain its financial condition, its ability to fulfill its obligations, and whether it has complied with the provisions of this chapter. The expenses and charges of the examination shall be paid to the State by the company or companies examined.(b) The provisions of section 3576 of this title shall apply to examinations conducted under this section.(c) All examination reports, preliminary examination reports or results, working papers, recorded information, documents and copies thereof produced by, obtained by, or disclosed to the Commissioner or any other person in the course of an examination made under this section are confidential and are not subject to subpoena and may not be made public by the Commissioner or an employee or agent of the Commissioner without the written consent of the company, except to the extent provided in this subsection. Nothing in this subsection shall prevent the Commissioner from using such information in furtherance of the Commissioner's regulatory authority under this title. The Commissioner may, in the Commissioner's discretion, grant access to such information to public officers having jurisdiction over the regulation of insurance in any other state or country, or to law enforcement officers of this State or any other state or agency of the federal government at any time, so long as such officers receiving the information agree in writing to hold it in a manner consistent with this section. (Added 1981, No. 28; amended 1983, No. 195 (Adj. Sess.), § 5(b); 1993, No. 235 (Adj. Sess.), § 9g, eff. June 21, 1994; 1997, No. 49, § 13, eff. June 26, 1997; 1999, No. 38, § 10, eff. May 20, 1999; 2003, No. 55, § 7; 2003, No. 105 (Adj. Sess.), § 8; 2019, No. 3, § 3, eff. April 18, 2019.)
8 V.S.A. § 6009
2021 Vermont Statutes|Title 8 - Banking and Insurance|Chapter 141 - Captive Insurance Companies|§ 6009. Grounds and procedures for suspension or revocation of license

§ 6009. Grounds and procedures for suspension or revocation of license|(a) The license of a captive insurance company may be suspended or revoked by the Commissioner for any of the following reasons:  (1) insolvency or impairment of capital or surplus; (2) Failure to meet the requirements of section 6004 of this title; (3) refusal or failure to submit an annual report, as required by this chapter, or any other report or statement required by law or by lawful order of the Commissioner; (4) failure to comply with the provisions of its own charter, bylaws, or other organizational document; (5) failure to submit to or pay the cost of examination or any legal obligation relative thereto, as required by this chapter; (6) use of methods that, although not otherwise specifically prohibited by law, nevertheless render its operation detrimental or its condition unsound with respect to the public or to its policyholders; or (7) failure otherwise to comply with the laws of this State.   (b) If the Commissioner finds, upon examination, hearing, or other evidence, that any captive insurance company has violated any provision of subsection (a) of this section, the Commissioner may suspend or revoke such company's license if the Commissioner deems it in the best interest of the public and the policyholders of such captive insurance company, notwithstanding any other provision of this title. (Added 1981, No. 28; amended 1997, No. 49, § 14, eff. June 26, 1997; 1999, No. 38, § 11, eff. May 20, 1999; 2003, No. 55, § 7.)