reglab/statecodes huggingface dataset:
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-331 - Premium rates

(1)
No premium rate may be used until either a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the commissioner.
(2)
Either a specific schedule of premium rates, or a methodology for determining premium rates, shall be established in accordance with actuarial principles for various categories of enrollees, provided that the premium applicable to an enrollee shall not be individually determined based on the status of the enrollee's health. However, the premium rates shall not be excessive, inadequate or unfairly discriminatory. A certification by a qualified actuary or other qualified person acceptable to the commissioner as to the appropriateness of the use of the methodology, based on reasonable assumptions, shall accompany the filing along with adequate supporting information.
(3)
The commissioner shall approve the schedule of premium rates or methodology for determining premium rates if the requirements of subsection (2) are met. If the commissioner disapproves the filing, he shall notify the health maintenance organization. In the notice, the commissioner shall specify the reasons for his disapproval. A hearing will be conducted within thirty (30) days after a request in writing by the person filing.
Laws, 1995, ch. 613, § 16, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-333 - Rules and regulations generally; exemptions from certification requirement

(1)
The commissioner may, after notice and hearing, promulgate rules and regulations as are necessary to provide for the licensing of health maintenance organization producers. The rules shall establish:
(a)
The requirements for licensure of resident health maintenance organization producers;
(b)
The conditions for entering into reciprocal agreements with other jurisdictions for the licensure of nonresident health maintenance organization producers;
(c)
Any examination, prelicensing or continuing education requirements;
(d)
The requirements for registering and terminating the appointment of health maintenance organization producers;
(e)
Any requirements for registering any assumed names or office locations in which an health maintenance organization producer does business;
(f)
The conditions for health maintenance organization producer license renewal;
(g)
The grounds for denial, refusal, suspension or revocation of an health maintenance organization producer's license;
(h)
Any required fees for the licensing activities of health maintenance organization producers; and
(i)
Any other requirement or procedure and any form as may be reasonably necessary to provide for the effective administration of the licensing of health maintenance organization producers under this section.
(2)
The commissioner may by rule exempt certain classes of persons from the requirement of obtaining a license:
(a)
If the functions they perform do not require special competence, trustworthiness or the regulatory surveillance made possible by licensing; or
(b)
If other existing safeguards make regulation unnecessary.
Laws, 1995, ch. 613, § 17, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-335 - Operation of health maintenance organizations by insurance companies and medical service corporations

(1)
An insurance company licensed in this state, or a hospital or medical service corporation authorized to do business in this state, may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this article. Any two (2) or more insurance companies, hospital or medical service corporations, or subsidiaries or affiliates, may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary thereof, which health maintenance organization shall be subject to the provisions of this article.
(2)
Notwithstanding any provision of insurance and hospital or medical service corporation laws, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage if the health maintenance organization fails to meet its obligations.
The enrollees of a health maintenance organization constitute a permissible group under such laws. Among other things, under the contracts, the insurer or hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers.
Laws, 1995, ch. 613, § 18, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-337 - Examination of health maintenance organizations and providers; acceptance of reports in lieu of examinations

(1)
The commissioner shall make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state but not less frequently than once every five (5) years at the expense of the health maintenance organization and provider with whom the health maintenance organization has contracted according to relevant statutes which govern examinations of insurance companies under the insurance laws of this state.
(2)
The State Health Officer may make an examination concerning the quality assurance program of the health maintenance organization and of any providers with whom such organization has contracts, agreements or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state but not less frequently than once every five (5) years.
(3)
Every health maintenance organization and provider shall submit its books and records for such examinations and in every way facilitate the completion of the examination. For the purpose of examinations, the commissioner and the State Health Officer may administer oaths to, and examine the officers and agents of, the health maintenance organization and the principals of providers concerning their business as per existing insurance laws, rules and regulations.
(4)
The expenses of examinations under this section shall be assessed against the health maintenance organization being examined as per existing laws for examination of insurance companies or the State Health Officer for whom the examination is being conducted.
(5)
In lieu of such examination, the commissioner or State Health Officer may accept the report of an examination made by the Commissioner of Insurance or the State Health Officer of another state.
Laws, 1995, ch. 613, § 19; Laws, 2012, ch. 364, § 3, eff. 7/1/2012.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-341 - Rehabilitation, liquidation or administrative supervision of health maintenance organizations

(1)
Any rehabilitation, liquidation or administrative supervision of a health maintenance organization shall be deemed to be the same as the rehabilitation, liquidation or administrative supervision of an insurance company and shall be conducted under the supervision of the commissioner pursuant to the law governing the rehabilitation, liquidation, and administrative supervision of insurance companies. The commissioner may apply for an order directing him to rehabilitate or liquidate a health maintenance organization upon any one or more grounds set out in Section
83-41-325
or when in his opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this state. Enrollees shall have the same priority in the event of liquidation or rehabilitation as the law provides to policyholders of an insurer.
(2)
For purpose of determining the priority of distribution of general assets, claims of enrollees and enrollees' beneficiaries shall have the same priority as established by the Rehabilitation and Liquidation Act (Section
83-24-1
et seq., Mississippi Code of 1972) for policyholders and beneficiaries of insureds of insurance companies. If an enrollee is liable to any provider for services provided pursuant to and covered by the health care plan, that liability shall have the status of an enrollee claim for distribution of general assets.
(3)
Any provider who is obligated by statute or agreement to hold enrollees harmless from liability for services provided pursuant to and covered by a health care plan shall have a priority of distribution of the general assets immediately following that of enrollees and enrollees' beneficiaries as described herein, and immediately preceding the priority of distribution described in Section
83-24-1
et seq., Mississippi Code of 1972.
Laws, 1995, ch. 613, § 21, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-343 - Remedies for correction of financial conditions of health maintenance organizations deemed hazardous to enrollees, creditors, or general public and violations of article

(1)
Whenever the commissioner determines that the financial condition of any health maintenance organization is such that its continued operation might be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this article, he may, after notice and hearing, order the health maintenance organization to take such action as may be reasonably necessary to rectify such condition or violation, including but not limited to one or more of the following:
(a)
Reduce the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the commissioner;
(b)
Reduce the volume of new business being accepted;
(c)
Reduce expenses by specified methods;
(d)
Suspend or limit the writing of new business for a period of time;
(e)
Increase the health maintenance organization's capital and surplus by contribution; or
(f)
Take such other steps as the commissioner may deem appropriate under the circumstances.
(2)
For purposes of this section, the violation by a health maintenance organization of any law of this state to which such health maintenance organization is subject shall be deemed a violation of this article.
(3)
The commissioner is authorized, by rules and regulations, to set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors, or the general public and to set standards for evaluating the financial condition of any health maintenance organization, which standards shall be consistent with the purposes expressed in subsection (1) of this section.
(4)
The remedies and measures available to the commissioner under this section shall be in addition to, and not in lieu of, the remedies and measures available to the commissioner under the provisions of the insurance laws of the State of Mississippi.
Laws, 1995, ch. 613, § 22, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-345 - Adoption of rules and regulations

The commissioner may, after notice and hearing, promulgate reasonable rules and regulations, as are necessary or proper to carry out the provisions of this article.
Laws, 1995, ch. 613, § 23, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-347 - Fees

(1)
Every health maintenance organization subject to this article shall pay to the commissioner the following fees:
(a)
For filing an application for a certificate of authority for a health maintenance organization and amendment thereto....................$5,000.00;
(b)
For filing an amendment to the organization documents that requires approval....................$ 50.00;
(c)
For filing an amendment "for information only"....................$ 25.00;
(d)
For filing each annual report....................$ 500.00;
(e)
Annual renewal of Certificate of Authority....................$ 500.00;
(f)
Policy forms, certificates, endorsements, riders, applications and rates....................$ 15.00;
(2)
The State Health Officer may utilize state employees or he may contract with other persons, companies, corporations and entities to carry out the duties and responsibilities under this article. If it is necessary to contract for the performance of the duties and responsibilities required under this article, the expense for the services shall be charged to the carrier and paid directly to the contracting party. The charge shall be approved by the State Health Officer prior to the services being rendered when sufficient information is available to the State Health Officer, though the carrier is responsible for all charges expended when additional services are necessary to carry out the duties and responsibilities for finalization of the licensing process. The method and procedure for the payment of the expenses may be addressed in the regulations promulgated under this article.
Laws, 1995, ch. 613, § 24, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-351 - Solicitation of enrollees

(1)
This provision shall not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance law or the hospital or medical service corporation laws of this state except with respect to its health maintenance organization activities authorized and regulated pursuant to this article.
(2)
Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.
Laws, 1995, ch. 613, § 26, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-353 - Documents deemed public documents

All applications, filings and reports required under this article shall be treated as public documents, except those which are trade secrets or privileged or confidential quality assurance, commercial or financial information, other than any annual financial statement that may be required under Section
83-41-317
.
Laws, 1995, ch. 613, § 27, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-357 - Contracting authority of State Health Officer

The State Health Officer in carrying out his obligations under this article, may contract with qualified persons to make recommendations concerning the determinations required to be made by him. The recommendations may be accepted in full or in part by the State Health Officer.
Laws, 1995, ch. 613, § 29, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-359 - Acquisitions, mergers and consolidations of health maintenance organizations

No person may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the consummation thereof, that person would, directly or indirectly, (or by conversion or by exercise of any right to acquire) be in control of the health maintenance organization, and no person may enter into an agreement to merge or consolidate with or otherwise to acquire control of a health maintenance organization, unless, at the time any offer, request or invitation is made or any agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, the person has filed with the commissioner and has sent to the health maintenance organization, information required by the commissioner substantially similar to the information required pursuant to Section
83-6-1
et seq., Mississippi Code of 1972, and the offer, request, invitation, agreement or acquisition has been approved by the commissioner.
Laws, 1995, ch. 613, § 30, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-361 - Adoption of coordination of benefits provisions

(1)
Health maintenance organizations are permitted, but not required, to adopt coordination of benefits provisions to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two (2) or more group health insurance or health care plans.
(2)
To the extent necessary for health maintenance organizations to meet their obligations as secondary carriers under the rules for coordination, health maintenance organizations shall make payments for services that are covered under the terms of their group contracts or evidence of coverage.
Laws, 1995, ch. 613, § 31, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 7 - HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION AND OTHER PREPAID HEALTH BENEFIT PLANS PROTECTION ACT (§§ 83-41-301 — 83-41-365) › Section 83-41-365 - Contracting authority of commissioner

The commissioner may contract with the necessary personnel to carry out the duties and responsibilities created by this article and make assessments for the expenses incurred in carrying out the duties and responsibilities of this article.
Laws, 1995, ch. 613, § 33, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-401 - Short title

This article shall be known and may be cited as the "Patient Protection Act of 1995."
Laws, 1995, ch. 613, § 36, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-403 - Definitions

As used in this article:
(a)
"Department" means the Mississippi Department of Insurance.
(b)
"Managed care plan" means a plan operated by a managed care entity as described in paragraph (c) of this section that provides for the financing and delivery of health care services to persons enrolled in such plan through:
(i)
Arrangements with selected providers to furnish health care services;
(ii)
Explicit standards for the selection of participating providers;
(iii)
Organizational arrangements for ongoing quality assurance, utilization review programs and dispute resolution; and
(iv)
Financial incentives for persons enrolled in the plan to use the participating providers, products and procedures provided for by the plan.
(c)
"Managed care entity" includes a licensed insurance company, hospital or medical service plan, health maintenance organization (HMO), an employer or employee organization, or a managed care contractor as described in paragraph (d) of this section that operates a managed care plan.
(d)
"Managed care contractor" means a person or corporation that:
(i)
Establishes, operates or maintains a network of participating providers;
(ii)
Conducts or arranges for utilization review activities; and
(iii)
Contracts with an insurance company, a hospital or medical service plan, an employer or employee organization, or any other entity providing coverage for health care services to operate a managed care plan.
(e)
"Participating provider" means a physician, hospital, pharmacy, pharmacist, dentist, nurse, chiropractor, optometrist, or other provider of health care services licensed or certified by the state, that has entered into an agreement with a managed care entity to provide services, products or supplies to a patient enrolled in a managed care plan.
Laws, 1995, ch. 613, § 37, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-405 - Requirement of certification of managed care plans offered or provided to persons residing in Mississippi; termination of plans

The department shall establish a process for the certification of managed care plans offered or provided to persons residing in Mississippi. No such plan shall be offered or provided to persons residing in this state unless it has been certified by the department. Any managed care plan certified by the department must be recertified annually, and the department shall establish procedures to ensure the continued compliance with the requirements of Section
83-41-409
through the recertification process. The department shall terminate the certificate of any managed care plan if such plan no longer meets the applicable requirements for certification. The department shall provide any such plan with an opportunity for a hearing on the proposed termination.
Laws, 1995, ch. 613, § 38, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-407 - Fees

The department shall establish a fee to cover the costs of issuing and renewing the certifications authorized by this article and the fees shall be used solely for the administration of this article.
Laws, 1995, ch. 613, § 39, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-409 - Conditions for certification or recertification

In order to be certified and recertified under this article, a managed care plan shall:
(a)
Provide enrollees or other applicants with written information on the terms and conditions of coverage in easily understandable language including, but not limited to, information on the following:
(i)
Coverage provisions, benefits, limitations, exclusions and restrictions on the use of any providers of care;
(ii)
Summary of utilization review and quality assurance policies; and
(iii)
Enrollee financial responsibility for copayments, deductibles and payments for out-of-plan services or supplies;
(b)
Demonstrate that its provider network has providers of sufficient number throughout the service area to assure reasonable access to care with minimum inconvenience by plan enrollees;
(c)
File a summary of the plan credentialing criteria and process and policies with the State Department of Insurance to be available upon request;
(d)
Provide a participating provider with a copy of his/her individual profile if economic or practice profiles, or both, are used in the credentialing process upon request;
(e)
When any provider application for participation is denied or contract is terminated, the reasons for denial or termination shall be reviewed by the managed care plan upon the request of the provider; and
(f)
Establish procedures to ensure that all applicable state and federal laws designed to protect the confidentiality of medical records are followed.
Laws, 1995, ch. 613, § 40, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-411 - Compliance with article by health maintenance organizations

Health maintenance organizations must comply with the certification requirements in this article in addition to such other laws as might relate thereto.
Laws, 1995, ch. 613, § 41, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-413 - Regulations

The department shall adopt regulations to implement the provisions of this article and may obtain any information from managed care plans that is necessary to determine if such plan should be certified or recertified.
Laws, 1995, ch. 613, § 42, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-415 - Applicability of Articles 7 and 9 to Division of Medicaid in Office of Governor

Articles 7 and 9 do not apply to the Division of Medicaid in the Office of the Governor.
Laws, 1995, ch. 613, § 43, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 41 - HOSPITAL AND MEDICAL SERVICE ASSOCIATIONS AND CONTRACTS (§§ 83-41-1 — 83-41-417) › Article 9 - PATIENT PROTECTION ACT OF 1995 (§§ 83-41-401 — 83-41-417) › Section 83-41-417 - Geographic areas served; opportunity to apply for participation

A health maintenance organization as defined in Section
83-41-303
, and a managed care entity as defined in Section
83-41-403
, shall establish procedures to give interested health care providers located in the geographic area served an opportunity to apply for participation.
Laws, 1995, ch. 613, § 44, eff. 7/1/1995.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-1 - Citation

This chapter shall be known and may be cited as the "Nonprofit Dental Service Corporation Law."
Codes, 1942, § 8775-01; Laws, 1962, ch. 234, § 1, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-3 - Definitions

As used in this chapter:
(a)
"Dentists" means persons holding a license to practice dentistry under Sections
73-9-1
through
73-9-65
, Mississippi Code of 1972.
(b)
"Dental services" include the general and usual services rendered and care administered by dentists as defined in Sections
73-9-1
through
73-9-65
, Mississippi Code of 1972.
(c)
"Nonprofit dental service corporation" includes a corporation organized and operated under the provisions of Section
79-11-101
, Mississippi Code of 1972, and all other applicable statutes governing nonprofit corporations.
(d)
"State Board of Health" means Mississippi State Board of Health.
(e)
"Court" means the chancery court of the county where the principal office of the nonprofit dental corporation is or is to be located.
Codes, 1942, § 8775-02; Laws, 1962, ch. 234, § 2; Laws, 1997, ch. 410, § 22, eff. 7/1/1997.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-5 - Unauthorized nonprofit dental service forbidden

It shall be unlawful for any person, copartnership, association, common law trust, or corporation, except when especially organized and authorized under the provisions of the nonprofit corporation statutes for the purpose, to establish, maintain, or operate a nonprofit dental service plan whereby dental services may be provided to persons or groups of persons for prepayment, periodical, or lump sum payments, but this shall not be construed as preventing a person, copartnership, association, common law trust, or corporation from furnishing dental services among its or his employees when the employee is not charged for such service. Nor shall any provision in this chapter be construed to apply to beneficial, benevolent, fraternal, benefit societies having a lodge system and representative form of government.
Codes, 1942, § 8775-03; Laws, 1962, ch. 234, § 3; Laws, 1997, ch. 307, § 6, eff. 7/1/1997.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-7 - Regulation and supervision

A nonprofit dental service corporation shall be subject to regulation and supervision by the state board of health, state auditor, and the attorney general as provided by this chapter. It shall not be subject to the laws of this state now in force, except as herein specifically stated, relating to insurance and corporations engaged in the business of insurance, nor to any law hereafter enacted relating to insurance and corporations engaged in the business of insurance, unless such law specifically and in exact terms applies to such nonprofit dental service corporation.
Codes, 1942, § 8775-04; Laws, 1962, ch. 234, § 4, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-9 - License

A nonprofit dental service corporation may not enter into dental service contracts under the provisions hereof until it has procured a formal certificate or license from the state board of health authorizing it to do so. Application for such certificate of authority or license shall be made on such forms as the state board of health may prescribe and shall be accompanied by the following documents:
(a)
certified copy of charter of incorporation,
(b)
certified copy of current bylaws,
(c)
an affidavit of the secretary of the Mississippi State Board of Dental Examiners setting forth that he has satisfactory evidence that at least twenty percent (20%) of the licensed dentists residing and actively practicing in the state have agreed to render professional service to subscribers under such plan,
(d)
a certificate from the Mississippi State Board of Dental Examiners approving the licensing of such dental service corporation, and
(e)
such other information as the state board of health may require concerning the public interest, welfare, and necessity of licensing such dental service corporation. The state board of health shall issue a certificate of authority or license upon payment of a fee of Twenty-five Dollars ($25.00) and upon being satisfied that the public interest, welfare, and necessity will be served by so doing. All licenses issued to every such corporation shall expire on the last day of the next succeeding March, but shall be subject to annual renewal under the foregoing terms and conditions.
Codes, 1942, § 8775-05; Laws, 1962, ch. 234, § 5, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-11 - Scope of service

(1)
A nonprofit dental service corporation may, by its articles of incorporation, its bylaws, or resolutions of its board of directors, limit the dental services that it will provide for its subscribers and may divide such dental services as it elects to provide into classes or kinds; and it may enter into contracts with its subscribers or groups of subscribers to secure dental services of any kind or class so named and delimited.
(2)
A nonprofit dental service corporation shall not provide dental services for its subscribers otherwise than through licensed dentists.
(3)
A nonprofit dental service corporation shall provide dental services only to persons domiciled within the state; but if a subscriber regularly domiciled within the state and entitled to dental services, or any of his dependents so entitled, necessarily employs dental services within the meaning of this chapter while absent from the state, a dental service corporation to which he is a subscriber may, in its discretion and if satisfied as to the necessity for such services and satisfied that it was such as the subscriber would have been entitled to under similar circumstances in this state, pay to the dentist or dentists who rendered the services such fees and charges as would have been payable if the services had been rendered in this state. A nonprofit dental service corporation organized under the laws of this state and operating near its boundaries may, with the consent of the proper officers of and as authorized by the law of the adjacent state, provide dental services therein, but all operations of any such corporation, whether within or without this state, shall remain at all times subject to the provisions of this chapter.
(4)
All dental services provided by or on behalf of a nonprofit dental service corporation shall be in accordance with the best dental practice in the community at the time, but the corporation providing such services shall not be liable for injuries resulting from negligence, misfeasance, malfeasance, nonfeasance, or malpractice on the part of any officer or employee or on the part of any dentist in the course of rendering dental services to subscribers; and the corporation may so provide in its contracts with subscribers.
Codes, 1942, § 8775-05; Laws, 1962, ch. 234, § 5, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-13 - Rights of dentists

(1)
Every dentist practicing within the area covered by any nonprofit dental service corporation shall have the right, on complying with such regulations as the corporation may make and with the approval of the state board of health, to register with such corporation for general or special dental service, as the case may be, within that area. Any nonprofit dental service corporation may, with the approval of the state board of health and the state board of dental examiners, remove from its register the name of any dentist, after due notice and hearing, for cause satisfactory to the corporation.
(2)
A nonprofit dental service corporation shall impose no restrictions on the dentists who administer to its subscribers as to methods of diagnosis or treatment. The relation between a subscriber or any of his dependents and the dentist shall be identical with the relation that ordinarily exists in the community between such doctor and his patient. No person shall be permitted to interfere with a patient's choice or selection of his dentist after that choice or selection has been made by an adult of sound mind; and any dentist shall have freedom of choice in registering for services with the corporation and may refuse to accept individual cases, so long as such refusal does not have the effect of an abrogation or revocation of any agreement existing between him and the corporation prior to its expiration.
(3)
All matters, disputes, or controversies relating to the dental services rendered by the dentists or any questions involving professional ethics shall be considered, acted upon, disposed of, and determined by dentists, as selected in a manner prescribed in the bylaws of the nonprofit dental service corporations.
Codes, 1942, § 8775-06; Laws, 1962, ch. 234, § 6, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-15 - Corporate rights and powers

In addition to the rights and powers that may be exercised by nonprofit corporations under Sections
79-11-1
through
79-11-33
, Mississippi Code of 1972, nonprofit dental service corporations created and organized under the provisions of this chapter shall be authorized to exercise the following rights and powers, to wit:
(a)
To encourage, foster, and finance professional and scientific study and research in the general field of dentistry; to make studies and conduct investigations designed to develop information, statistics, and knowledge pertaining to all aspects of dental service payment plans, and to assist in the education and enlightenment of the public concerning the needs and advantages of adequate dental treatment and care.
(b)
To enter into and carry out contracts for furnishing dental services to individuals and groups of individuals, provided, however, that no contract by or on behalf of any nonprofit dental service corporation shall provide for the payment of any cash or other material benefit by that corporation to a subscriber on account of illness or injury nor be in any way related to the payment of any such benefit by any other agency.
(c)
To procure and enter into contracts with dentists, hygienists, laboratory technicians, oral surgeons, hospitals, pharmacies, and other persons, firms, and corporations to carry out any of the objects and purposes of this corporation.
(d)
To operate an administrative office and dental clinics, laboratories, and other facilities appropriate or convenient for the rendition of dental services, and to employ personnel for the conduct thereof.
(e)
To establish and maintain funds secured through payments to be used to defray the cost of dental services, to predicate payments into such funds on actuarial prediction and experience, and to issue contracts entitling the holder or subscriber thereto to dental services as enumerated therein and subject to the terms and provisions as may be therein provided.
(f)
To establish eligibility requirements for individuals and groups of individuals seeking to subscribe to its dental service plans, and to determine the eligibility thereunder of persons subscribing to its contracts. Any and all requisites thus fixed and all contracts for dental services offered by the corporation shall be subject to the approval of the state board of health.
(g)
To accept gifts, donations, contributions and property by bequest or devise, or in trust, and to use and apply the same in furtherance of the objects and purposes of such corporation.
Codes, 1942, § 8775-07; Laws, 1962, ch. 234, § 7, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-17 - Limitation of subscriber's contract

A nonprofit dental service corporation may, as a condition precedent to entering into a contract with an applicant or group of applicants for dental service:
(a)
Require a physical examination of the applicant and of each of his dependents, if any, and proof of his or their substantial freedom from any disease or condition requiring immediate dental service or likely to require it within the next six (6) months before a contract becomes effective, or
(b)
require a waiting period after a contract is entered into and before the subscriber is entitled to dental service, or
(c)
require that the subscriber or someone on his behalf shall pay the stated fee or fees for dental services in the care of any given illness or injury or other condition requiring dental service before becoming entitled to treatment under the terms of the contract.
(d)
Provided, however, that nothing in this chapter shall be construed to require any individual, or group of individuals, to become a subscriber or subscribers to any such plan against his or their own free will and accord.
Codes, 1942, § 8775-08; Laws, 1962, ch. 234, § 8, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-19 - Officers may subscribe for service

Every department, commission, officer, or other agency of the state, or of any political subdivision thereof, who is authorized or charged by law with the duty of providing dental services within the meaning of this chapter for persons unable to provide it entirely at their own expense, or to procure it through persons to whose support and assistance they are by law entitled, is hereby empowered in the exercise of his authority to provide such service if, in his judgment, it is in the public interest so to do, through a subscription or subscriptions paid for from any lawfully available public funds with any nonprofit dental service corporation on behalf of any person or persons entitled to such relief. Provided, however, that the extent of public funds contributed to such services, other than those funds disbursed by the state welfare program, shall not exceed the limitations authorized by Section
25-15-103
, Mississippi Code of 1972.
Codes, 1942, § 8775-09; Laws, 1962, ch. 234, § 9, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-21 - Financial report

Every nonprofit dental service corporation shall, on or before the first day of March of every year, file with the state auditor of public accounts a statement verified by at least two (2) of the principal officers of the corporation, summarizing its financial activities during the calendar year immediately preceding and showing its financial condition at the close of business on the thirty-first day of December of that year. Such statement shall be in such form and shall contain such matter as the state auditor prescribes. The financial affairs and status of every such corporation may be examined by the attorney general of the state not less frequently than once in every three (3) years and, for that purpose, the attorney general and his assistants shall be entitled to the aid and cooperation of the officers and employees of the corporation and shall have convenient access to all books, records, papers, and documents that relate to the business of the corporation. They shall have authority to examine the officers, agents, employees, and subscribers for the dental services of the corporation, all cooperating dentists registered with the corporation, and all other persons having or having had substantial part in the work of the corporation in relation to its affairs, transactions, and financial condition. Such examinations shall be made at such times and with such frequency as the attorney general may determine. He or the state auditor may, at any time without making such examination, call on any such corporation for a written report, authenticated by at least two (2) of its principal officers, concerning the financial affairs and status of the corporation.
Codes, 1942, § 8775-10; Laws, 1962, ch. 234, § 10, eff. 5/7/1962.
Mississippi Code 1972 (2023) › Title 83 - INSURANCE (§§ 83-1-1 — 83-NEW-004) › Chapter 43 - NONPROFIT DENTAL SERVICE CORPORATIONS (§§ 83-43-1 — 83-43-37) › Section 83-43-23 - Investment

Surplus funds, if any, of any such corporation may be invested and, if invested, shall be in compliance with the requirements of law for the investment of the surplus of life insurance companies.
Codes, 1942, § 8775-11; Laws, 1962, ch. 234, § 11, eff. 5/7/1962.