reglab/statecodes huggingface dataset:
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 31 - South Carolina Property And Casualty Insurance Guaranty Association › Section 38-31-130. Exemption of Association from fees and taxes.

The association is exempt from payment of all fees and all taxes levied by this State or any of its political subdivisions, except taxes levied on real or personal property.
HISTORY: Former 1976 Code Section 38-31-130 [1962 Code Section 37-312.2; 1969 (56) 699] recodified as Section 38-65-330 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-19-130 [1962 Code Section 37-832; 1971 (57) 1001] recodified as Section 38-31-130 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 632.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 31 - South Carolina Property And Casualty Insurance Guaranty Association › Section 38-31-140. Rates.

The rates and premiums charged for insurance policies to which this chapter applies shall include amounts sufficient to recoup a sum equal to the amounts paid to the association by the member insurer less any amounts returned to the member insurer by the association. These rates may not be considered excessive because they contain an amount reasonably calculated to recoup assessments paid by the member insurer.
HISTORY: Former 1976 Code Section 38-31-140 [1962 Code Section 37-312.3; 1969 (56) 699] recodified as Section 38-65-340 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-19-140 [1962 Code Section 37-833; 1971 (57) 1001] recodified as Section 38-31-140 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 632.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 31 - South Carolina Property And Casualty Insurance Guaranty Association › Section 38-31-150. Immunity from liability for action taken under chapter.

There is no liability on the part of, and no cause of action of any nature may arise against, any member insurer, the association's agents or employees, the board of directors, or the director or his representatives for any act or omission in the performance of their powers and duties under this chapter. This section does not relieve the association of any of its liability.
HISTORY: Former 1976 Code Section 38-31-150 [1962 Code Section 37-312.4; 1969 (56) 699] recodified as Section 38-65-350 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-19-150 [1962 Code Section 37-834; 1971 (57) 1001] recodified as Section 38-31-150 by 1987 Act No. 155, Section 1; 1988 Act No. 402, Section 7; 1993 Act No. 181, Section 632.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 31 - South Carolina Property And Casualty Insurance Guaranty Association › Section 38-31-160. Stay of proceedings involving insolvent insurers; rights of Association in these proceedings.

All proceedings involving covered claims in which the insolvent insurer is a party or is obligated to defend a party in any court in this State must be stayed ninety days from the date insolvency is determined to permit proper defense by the association. The court may stay the proceedings for a longer period of time if the court finds the additional time is necessary to permit proper defense by the association. As to any judgment, decision, order, verdict, or finding based on the insurer's default or failure to defend the insured, the association may apply to have the judgment, decision, order, verdict, or finding set aside by the same court or administrator which made it and must be permitted to defend against the claim on its merits.
HISTORY: Former 1976 Code Section 38-31-160 [1962 Code Section 37-310; 1953 (48) 493] recodified as Section 38-65-80 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-19-160 [1962 Code Section 37-835; 1971 (57) 1001] recodified as Section 38-31-160 by 1987 Act No. 155, Section 1; 1988 Act No. 402, Section 8; 1993 Act No. 181, Section 632.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 31 - South Carolina Property And Casualty Insurance Guaranty Association › Section 38-31-170. Termination of Association by director.

(1) The director or his designee shall by order terminate the operation of the association as to any kind of insurance covered by this chapter with respect to which he has found, after hearing, that there is in effect a statutory or voluntary plan which:
(a) is a permanent plan which is adequately funded or for which adequate funding is provided; and
(b) extends, or will extend, to the South Carolina policyholders and residents protection and benefits with respect to insolvent insurers not substantially less favorable and effective to such policyholders and residents than the protection and benefits provided with respect to such kinds of insurance under this chapter.
(2) The director or his designee shall by the same order authorize discontinuance of future payments by insurers to the association with respect to the same kinds of insurance. However, the assessments and payments must continue, as necessary, to liquidate covered claims of insurers adjudged insolvent prior to the order and the related expenses not covered by such other plan.
(3) In the event the operation of the association is terminated as to all kinds of insurance within its scope, the association shall as soon as possible thereafter distribute the balance of remaining money and assets, after first discharging the association's duties with respect to prior insurer insolvencies and related expenses not covered by such other plan. The distribution must be to the insurers which are then writing in this State policies of the kinds of insurance covered by this chapter and which had made payments to this association, pro rata upon the basis of the aggregate of the payments made by the respective insurers during the period of five years next preceding the date of the order. Upon completion of the distribution with respect to all of the kinds of insurance covered by this chapter, this chapter is considered to have expired.
HISTORY: Former 1976 Code Section 38-19-170 [1962 Code Section 37-836; 1971 (57) 1001] recodified as Section 38-31-170 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 632.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-10. Short title.

This chapter may be cited as the Health Maintenance Organization Act of 1987.
HISTORY: Former 1976 Code Section 38-33-10 [1962 Code Section 37-331; 1968 (55) 2407; 1978 Act No. 441, Section 1] recodified as Section 38-67-10 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-25-10 [1962 Code Section 37-1132; 1974 (58) 2378] recodified as Section 38-33-10 by 1987 Act No. 155, Section 1; 1987 Act No. 83, Section 1 [amendment to former 1976 Code Section 38-25-10 transferred to Section 38-33-10 by 1987 Act No. 155, Section 24]; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-40. Issuance of certificate of authority; criteria and considerations; arrangements for participation of providers in each geographic area served.

(A) The director or his designee shall issue a certificate of authority to a person filing an application pursuant to Section 38-33-30 if, upon payment of the application fee prescribed in Section 38-33-220, the director or his designee is satisfied that:
(1) The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and possess good reputations.
(2) The health maintenance organization's proposed plan of operation has arrangements for an on-going quality assurance program.
(3) The health maintenance organization effectively provides or arranges for the provision of basic health care services for a fixed prepaid premium, except to the extent of reasonable requirements for deductibles or co-payments.
(4) The health maintenance organization is financially responsible, is able to meet its obligations to enrollees and prospective enrollees, and otherwise meets the requirements of this chapter. In making this determination, considerations by the director or his designee may include, but are not limited to:
(a) the financial soundness of the arrangements for health care services and the schedule of charges used in connection with them;
(b) the adequacy of working capital;
(c) an agreement with an insurer, a government, or other organization for insuring the payment of the cost of health care services or the provision for automatic applicability of an alternative coverage if the health maintenance organization is discontinued;
(d) an agreement with providers for the provision of health care services;
(e) a deposit of cash or securities submitted in accordance with Section 38-33-130.
(5) The enrollees are afforded an opportunity to participate in matters of policy and operation pursuant to Section 38-33-60.
(6) Nothing in the proposed method of operation, pursuant to Section 38-33-30 or by independent investigation, is contrary to the public interest.
(B) No health maintenance organization may be licensed unless it has employed or contracted with or made arrangements satisfactory to the director or his designee with both physicians and hospitals to participate as providers in each geographic area to be served, as identified by the health maintenance organization under Section 38-33-30.
HISTORY: Former 1976 Code Section 38-33-40 [1962 Code Section 37-334; 1968 (55) 2407; 1978 Act No. 441 Section 4] recodified as Section 38-67-40 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-25-40 [1962 Code Section 37-1134; 1974 (58) 2378] recodified as Section 38-33-40 by 1987 Act No. 155, Section 1; 1987 Act No. 83, Section 1 (amendment to former 1976 Code Section 38-25-40 transferred to Section 38-33-40 by 1987 Act No. 155, Section 24]; 1992 Act No. 403, Section 2; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-60. Members of governing body; advisory panels, etc.

(A) The governing body of any health maintenance organization may include providers, or other individuals, or both.
(B) The governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms.
HISTORY: Former 1976 Code Section 38-25-60 [1962 Code Section 37-1136; 1974 (58) 2378] recodified as Section 38-33-60 by 1987 Act No. 155, Section 1; 1987 Act No. 83, Section 1 [amendment to former 1976 Code Section 38-25-60 transferred to Section 38-33-60 by 1987 Act No. 155, Section 24]; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-70. Fiduciary relationship in handling of funds.

Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of an organization is responsible for the funds in a fiduciary relationship to the organization.
HISTORY: Former 1976 Code Section 38-25-70 [1984 Act No. 512, Part II, Section 32] recodified as Section 38-33-70 by 1987 Act No. 155, Section 1; 1987 Act No. 83, Section 1 (amendment to former 1976 Code Section 38-25-70 transferred to Section 38-33-70 by 1987 Act No. 155, Section 24]; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-100. Financial requirements before issuance of certificate of authority to health maintenance organization.

(A) No health maintenance organization may be issued a certificate of authority unless it is possessed of net worth of at least one million two hundred thousand dollars, six hundred thousand dollars of which must be capital if it is a stock health maintenance organization. After the issuance, the health maintenance organization shall maintain a net worth of not less than seven hundred fifty thousand dollars, six hundred thousand dollars of which must be capital if it is a stock health maintenance organization. Net worth means total assets less total liabilities. Instruments acceptable to the director or his designee may be utilized in determining net worth. If the director or his designee determines that the number of enrollees in the health maintenance organization is excessive or may become excessive in relation to the organization's net worth, the director or his designee may require that future enrollment be limited until it is no longer necessary.
(B) If the surplus of a stock health maintenance organization is less than twenty-five percent of the surplus initially required, as set forth in subsection (A), the health maintenance organization is considered delinquent, and the director or his designee may begin delinquency proceedings as provided by Chapter 27.
(C) If the capital of a stock health maintenance organization is impaired, the health maintenance organization is delinquent, and the director or his designee shall begin delinquency proceedings.
(D) If the surplus of a licensed mutual health maintenance organization is less than the sum of the capital and minimum surplus required to be maintained by a stock health maintenance organization licensed to write the same kind or kinds of business, the mutual health maintenance organization is considered delinquent, and the director or his designee may begin delinquency proceedings as provided by Chapter 27.
(E) If the surplus of a licensed mutual health maintenance organization is less than the minimum capital required to be possessed by a stock health maintenance organization licensed to write the same kind or kinds of business, the mutual health maintenance organization is delinquent, and the director or his designee shall begin delinquency proceedings.
HISTORY: Enacted as 1976 Code Section 38-25-100 by 1987 Act No. 83, Section 1; recodified as Section 38-33-100 by 1987 Act No. 155, Section 24; 1991 Act No. 13, Section 26; 1993 Act No. 181, Section 633; 2000 Act No. 312, Section 8.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-110. Complaint procedures; reports; malpractice claims; applicability of Freedom of Information Act.

(A)(1) Every health maintenance organization shall establish and maintain a complaint system which is approved by the director or his designee to provide reasonable procedures for the resolution of written complaints initiated by enrollees.
(2) Each health maintenance organization, with the annual report required in Section 38-33-90, shall submit to the department an annual report in a form the director prescribes which must include:
(a) a summary of written complaints handled through the health maintenance organization's approved complaint system. The summary must include the total number of complaints organized by the nature of the complaint and the average time taken to resolve the complaint;
(b) the number, amount, and disposition of malpractice claims made by enrollees of the health maintenance organization that it settled during the year.
(B) The director or his designee at any time may examine the complaint system. Information concerning complaints and malpractice claims filed pursuant to this section must be held in confidence and are not subject to disclosure under the Freedom of Information Act.
HISTORY: Enacted as 1976 Code Section 38-25-110 by 1987 Act No. 83, Section 1; recodified as Section 38-33-110 by 1987 Act No. 155, Section 24; 1992 Act No. 403, Section 4; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-120. Investment of funds.

With the exception of investments made in accordance with Section 38-33-50 (A)(1) and (2) and (B), the funds of a health maintenance organization must be invested only in securities or other investments permitted by the laws of this State for the investment of assets which qualify to cover policyholder obligations of life insurance companies or such other securities or investments as the director or his designee may permit.
HISTORY: Enacted as 1976 Code Section 38-25-120 by 1987 Act No. 83, Section 1; recodified as Section 38-33-120 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-150. Agent for organization; exemption from licensing requirements.

(A) An agent means a person who is appointed or employed by a health maintenance organization and who engages in solicitation of membership in the organization. This definition does not include a person enrolling members on behalf of an employer, union, or other organization to whom a master subscriber contract has been issued.
(B) The department may by regulation exempt certain classes of persons from the requirement of obtaining a license:
(1) if the functions they perform do not require special competence, trustworthiness, or the regulatory surveillance made possible by licensing; or
(2) if other existing safeguards make regulation unnecessary.
HISTORY: Enacted as 1976 Code Section 38-25-150 by 1987 Act No. 83, Section 1; recodified as Section 38-33-150 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-160. Operation of health maintenance organization by insurance company; contracts for cost of care.

(A) An insurance company licensed in this State may through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this chapter. Any two or more such insurance companies or subsidiaries or affiliates thereof may jointly organize and operate a health maintenance organization.
(B) An insurer 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 in the event of the failure of the health maintenance organization to meet its obligations. Among other things, under such contracts, the insurer may make benefit payments to health maintenance organizations for health care services rendered by providers.
HISTORY: Enacted as 1976 Code Section 38-25-160 by 1987 Act No. 83, Section 1; recodified as Section 38-33-160 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-170. Examination of affairs of organization; quality of health care services; books and records; expense of examination; reports.

(A) The director or his designee may make an examination of the affairs of a health maintenance organization and providers with whom the 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 years. The director or his designee may accept the report of an examination made by the state where the health maintenance organization is domiciled.
(B) The director or his designee may make an examination concerning the quality of health care service of a health maintenance organization and providers with whom the 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 years.
(C) Every health maintenance organization and provider shall submit its relevant books and records for the examinations and facilitate them. For the purpose of examinations, the director or his designee and the department may administer oaths to and examine the officers and agents of the health maintenance organization and the principals of the providers concerning their business.
(D) The expenses of examinations under this section are assessed against the organization being examined and remitted to the director or his designee for whom the examination is being conducted.
HISTORY: Enacted as 1976 Code Section 38-25-170 by 1987 Act No. 83, Section 1; recodified as Section 38-33-170 by 1987 Act No. 155, Section 24; 1992 Act No. 403, Section 5; 1993 Act No. 181, Section 633; 2018 Act No. 219 (H.4657), Section 3, eff May 18, 2018.
Effect of Amendment
2018 Act No. 219, Section 3, in (A), in the first sentence, substituted "five years" for "three years"; and in (B), substituted "five years" for "three years".
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-190. Rehabilitation, liquidation, or conservation of a health maintenance organization; priorities.

Any rehabilitation, liquidation, or conservation of a health maintenance organization is considered to be the rehabilitation, liquidation, or conservation of an insurance company and must be conducted under the supervision of the director or his designee pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies. The director or his designee may apply for an order directing him to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more grounds set out in Sections 38-27-310 and 38-27-370, 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.
HISTORY: Enacted as 1976 Code Section 38-25-190 by 1987 Act No. 83, Section 1; recodified as Section 38-33-190 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-200. Implementation of regulations.

The department may, after notice and hearing, promulgate regulations to carry out the provisions of this chapter.
HISTORY: Enacted as 1976 Code Section 38-25-200 by 1987 Act No. 83, Section 1; recodified as Section 38-33-200 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-210. Notification of grounds for denial, suspension or revocation of certificate of authority; hearings; judicial review.

(A) When the director or his designee 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, he shall notify the health maintenance organization in writing specifically stating the grounds for denial, suspension, or revocation and fixing a time of at least thirty days thereafter for a hearing on the matter. However, if the ground for suspension or revocation relates solely to financial condition, the director or his designee may immediately and without hearing suspend the certificate of authority of the health maintenance organization.
(B) The provisions of Article 3, Chapter 23, Title 1, apply to administrative proceedings under this section. Whenever the director or his designee issues an order of suspension without an administrative hearing before the director or his designee based upon a health maintenance organization's financial condition, as authorized under subsection (A), the health maintenance organization has a right to judicial review before the Administrative Law Court in accordance with law.
HISTORY: Enacted as 1976 Code Section 38-25-210 by 1987 Act No. 83, Section 1; recodified as Section 38-33-210 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-220. Fees.

(A) Every health maintenance organization subject to this chapter shall pay to the department the following fees:
(1) for filing an application for a certificate of authority, two thousand dollars;
(2) for filing an amendment to the organization documents that requires approval, one hundred dollars;
(3) for filing each annual report, one thousand dollars;
(4) for transferring a certificate of authority from one entity to another which qualifies for such a certificate of authority, two thousand dollars.
(B) Fees charged under this section must be deposited in the general fund of the state. Fees required in this section must be fully earned when paid and are not refundable, proratable, nor transferable.
HISTORY: Enacted as 1976 Code Section 38-25-220 by 1987 Act No. 83, Section 1; recodified as Section 38-33-220 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-230. Levy of administrative penalty in lieu of revocation or suspension of certificate of authority; monetary penalty; notice and hearings; injunctions.

(A) The director or his designee, in lieu of revocation or suspension of a certificate of authority under Section 38-33-180, may levy an administrative penalty of not more than fifteen thousand dollars for each violation of state or federal law the Department of Insurance is authorized to enforce or ground as prescribed therein. A series of acts by an organization which merely implement a basic violation and are not separate and distinct violations of an independent nature are considered to be part of the basic violation and only one penalty may be imposed. A monetary penalty may be imposed under this paragraph only after notice and an opportunity to be heard have been afforded in accordance with Section 38-33-210.
(B) Whenever the director or his designee has reason to believe that any person has transacted the business of, or is about to transact the business of, a health maintenance organization without a certificate of authority, he may cause a complaint to be filed in the court of common pleas of Richland County to enjoin and restrain the unauthorized transaction of business. The court has power to make and enter an order or judgment awarding such preliminary or final injunctive relief as may be necessary and proper. In addition, the court may impose a civil penalty of not more than ten thousand dollars upon such person for each unauthorized act of business so transacted.
HISTORY: Enacted as 1976 Code Section 38-25-230 by 1987 Act No. 83, Section 1; recodified as Section 38-33-230 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633; 2018 Act No. 219 (H.4657), Section 4, eff May 18, 2018.
Effect of Amendment
2018 Act No. 219, Section 4, in (A), in the first sentence, deleted "may" following "his designee", and inserted "of state or federal law the Department of Insurance is authorized to enforce" following "each violation".
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-240. Application of provisions of insurance law or law relating to solicitation or advertising by health professionals; practice of medicine, dentistry or other healing profession.

(A) Except as otherwise specifically provided, the provisions of the insurance law do not apply to any health maintenance organization granted a certificate of authority under this chapter.
(B) Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, are not construed to violate any provision of law relating to solicitation or advertising by health professionals.
(C) No health maintenance organization authorized under this chapter is considered to be practicing medicine, dentistry, or other healing professions.
HISTORY: Enacted as 1976 Code Section 38-25-240 by 1987 Act No. 83, Section 1; recodified as Section 38-33-240 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-250. Records of organization as public documents; trade secrets, etc.

All applications and filings required under Section 38-33-30 and any annual and quarterly financial reports required under Section 38-33-90 must be treated as public documents. Nothing herein may be construed to require disclosure of trade secrets, privileged or confidential commercial information, or replies to a specific request for information made by the director or his designee.
HISTORY: Enacted as 1976 Code Section 38-25-250 by 1987 Act No. 83, Section 1; recodified as Section 38-33-250 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-260. Confidentiality of health records.

Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization is confidential and may not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this chapter, or upon the express consent of the enrollee or applicant, or pursuant to statute or court order for the production of evidence or the discovery thereof, or in the event of claim or litigation between such person and the health maintenance organization wherein the data or information is pertinent. A health maintenance organization is entitled to claim any statutory privileges against such disclosure which the provider who furnished the information to the health maintenance organization is entitled to claim.
HISTORY: Enacted as 1976 Code Section 38-25-260 by 1987 Act No. 83, Section 1; recodified as Section 38-33-260 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-270. Contractual powers of Department to assist in investigative duties; assessments for consulting expenses.

(A) The director or his designee, in carrying out the obligations under Sections 38-33-40, 38-33-170(B), and 38-33-180(A), 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 director or his designee.
(B) The director or his designee may assess the health maintenance organization directly for consulting expenses incurred pursuant to subsection (A) and require the organization to remit payment directly to the consultant. These expenses must be reasonable. The director or his designee is not required to but may consider the results of a quality assurance examination made at an appropriate time by a person with whom the health maintenance organization has a contract to provide health care services or by a person who has a legitimate interest in the quality of care provided by the organization.
HISTORY: Enacted as 1976 Code Section 38-25-270 by 1987 Act No. 83, Section 1; recodified as Section 38-33-270 by 1987 Act No. 155, Section 24; 1992 Act No. 403, Section 7; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-280. Acquisition or exchange of securities of a health maintenance organization; merger or consolidation of HMO.

(A) 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 department and has sent to the health maintenance organization, information required by Section 38-21-70 and the offer, request, invitation, agreement, or acquisition has been approved by the director or his designee. Approval by the director or his designee is governed by Section 38-21-90.
(B) The provisions of Section 38-21-250 shall apply to health maintenance organizations.
HISTORY: Enacted as 1976 Code Section 38-25-280 by 1987 Act No. 83, Section 1; recodified as Section 38-33-280 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633; 2002 Act No. 228, Section 6, eff May 1, 2002.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-290. Participation by physician, podiatrist, optometrist, or oral surgeon as provided in HMO.

No health maintenance organization may prohibit any licensed physician, podiatrist, optometrist, or oral surgeon from participating as a provider in the organization on the basis of his profession. Nothing in this section may be construed to interfere in any way with the medical decision of the primary health care provider to use or not use any health professional on a case-by-case basis.
HISTORY: 1976 Code Section 38-25-80 [1986 Act No. 440; repealed by 1987 Act No. 155, Section 25(f)] recodified as Section 38-33-80 by 1987 Act No. 155, Section 1; substance transferred to Section 38-33-290 by 1987 Act No. 83, Section 1; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-300. Liability for participation in quality of care or utilization review.

There may be no monetary liability on the part of, and no cause of action may arise against, any person who participates in quality of care or utilization reviews by a peer review committee established in accordance with regulations of the department under Section 38-33-40(A)(2) for any act performed during such reviews, provided such person acts in good faith and without malice, has made a reasonable effort to obtain the facts of the matter, and reasonably believes that the action taken is warranted by the facts.
HISTORY: Enacted as 1976 Code Section 38-25-300 by 1987 Act No. 83, Section 1; recodified as Section 38-33-300 by 1987 Act No. 155, Section 24; 1993 Act No. 181, Section 633.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 33 - Health Maintenance Organizations › Section 38-33-325. Obstetrician-gynecologist services; referrals; authorization for services; member notification of plan provisions.

(A) A health benefit plan shall allow a female enrollee thirteen years of age or older a minimum of two visits annually pursuant to the health benefit plan, without prior referral, to the health care services of an obstetrician-gynecologist in the health benefit plan.
(B) For any continuing treatment resulting from obstetrical or gynecological, or both, complications diagnosed during the two visits for a calendar year, authorization must be made for medical necessity directly by the health maintenance organization. Written communication should be sent by the obstetrician-gynecologist to the patient's primary care physician regarding the condition being treated within a reasonable time after each visit.
(C) A health benefit plan must notify its members of the provisions of this subsection (A). The information must be provided in the Summary Plan Description materials and enrollment materials.
(D) For purposes of this section:
(1) "Health benefit plan" means a health maintenance organization, a preferred provider plan, an exclusive provider plan, or other managed care arrangement plan;
(2) "Health care services" means the full scope of medically necessary services provided by the participating obstetrician-gynecologist in the care of or related to the female reproductive system and breasts.
HISTORY: 1998 Act No. 329, Section 2.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 35 - Mutual Benevolent Aid Associations › Section 38-35-10. Formation of mutual associations.

Members of religious denominations, local lodges, or fraternal orders under the control and supervision of a representative governing body within this State or of local labor organizations with a national or international charter or any number of persons, not less than twenty, a majority of whom must be bona fide residents of this State may, when investigated and approved by the director or his designee, form mutual associations, incorporated or unincorporated, for the purpose of aiding their members or their beneficiaries in times of sickness and death by levying equitable assessments for the payment of sick relief or death benefits upon compliance with this chapter.
HISTORY: Former 1976 Code Section 38-35-10 [1962 Code Section 37-441; 1968 (55) 2584; 1971 (57) 474; 1972 (57) 3116] has no comparable provisions in 1987 Act No. 155; Former 1976 Code Section 38-23-10 [1947 (45) 322; 1952 Code Section 37-1001; 1962 Code Section 37-1001] recodified as Section 38-35-10 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 634.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 35 - Mutual Benevolent Aid Associations › Section 38-35-20. Conduct of associations.

A mutual association may not have paid agents for the soliciting of business or members and must be conducted without profit.
HISTORY: Former 1976 Code Section 38-35-20 [1962 Code Section 37-442; 1968 (55) 2584] recodified as Section 38-71-10 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-23-20 [1947 (45) 322; 1952 Code Section 37-1002; 1962 Code Section 37-1002] recodified as Section 38-35-20 by 1987 Act No. 155, Section 1.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 35 - Mutual Benevolent Aid Associations › Section 38-35-30. Assessments.

Assessments must be made by a mutual association at the time an individual becomes a member or at the time of death or sickness of a member and for the purpose of paying benefits due the member because of death or sickness.
HISTORY: Former 1976 Code Section 38-35-30 [1962 Code Section 37-443; 1968 (55) 2584] no comparable provisions in 1987 Act No. 155; Former 1976 Code Section 38-23-30 [1947 (45) 322; 1952 Code Section 37-1003; 1962 Code Section 37-1003; 1984 Act No. 330] recodified as Section 38-35-30 by 1987 Act No. 155, Section 1.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 35 - Mutual Benevolent Aid Associations › Section 38-35-40. Annual report; certificate of compliance.

Mutual associations shall file an annual report with the department. If, after examination of the report, the director or his designee determines that the mutual association has complied with the insurance laws, he may issue it a certificate showing compliance.
HISTORY: Former 1976 Code Section 38-35-40 [1947 (45) 322; 1952 Code Section 37-453; 1962 Code Section 37-453] recodified as Section 38-71-70 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-23-40 [1947 (45) 322; 1952 Code Section 37-1004; 1962 Code Section 37-1004] recodified as Section 38-35-40 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 635.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 35 - Mutual Benevolent Aid Associations › Section 38-35-50. Examinations.

A mutual association is subject to any examination by the director or his designee which will enable him to determine that it has complied with the state insurance laws.
HISTORY: Former 1976 Code Section 38-35-50 [1962 Code Section 37-444; 1968 (55) 2569] recodified as Section 38-71-20 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-23-50 [1947 (45) 322; 1952 Code Section 37-1005; 1962 Code Section 37-1005] recodified as Section 38-35-50 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 636.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 35 - Mutual Benevolent Aid Associations › Section 38-35-60. Exemption from license fees.

Mutual associations shall not pay a license fee.
HISTORY: Former 1976 Code Section 38-35-60 [1962 Code Section 37-445; 1968 (55) 2582] recodified as Section 38-71-120 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-23-60 [1947 (45) 322; 1952 Code Section 37-1005; 1962 Code Section 37-1005] recodified as Section 38-35-60 by 1987 Act No. 155, Section 1.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 38 - Fraternal Benefit Societies › Section 38-38-10. Fraternal benefit society defined.

Any incorporated society, order, or supreme lodge, without capital stock, whether incorporated or not, conducted solely for the benefit of its members and their beneficiaries and not for profit, operated on a lodge system with ritualistic form of work, having a representative form of government, and which provides benefits in accordance with this chapter, is a fraternal benefit society.
HISTORY: 2000 Act No. 259, Section 1.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 38 - Fraternal Benefit Societies › Section 38-38-20. Lodge system operating requirements; lodges for children.

(A) A society is operating on the lodge system if it has a supreme governing body and subordinate lodges into which members are elected, initiated, or admitted in accordance with its bylaws, rules, and ritual. Subordinate lodges must be required by the bylaws of the society to hold regular meetings at least once in each month in furtherance of the purposes of the society.
(B) A society may, at its option, organize and operate lodges for children under the minimum age for adult membership. Membership and initiation in local lodges may not be required of these children, nor shall these children have a voice or vote in the management of the society.
HISTORY: 2000 Act No. 259, Section 1.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 38 - Fraternal Benefit Societies › Section 38-38-30. Representative form of government requirements.

A society has a representative form of government when:
(1) it has a supreme governing body constituted in one of the following ways:
(a) the supreme governing body is an assembly composed of delegates elected directly by the members or at intermediate assemblies or conventions of members or their representatives, together with other delegates as may be prescribed in the society's bylaws. A society may provide for election of delegates by mail. The elected delegates constitute a majority in number and may not have less than two-thirds of the votes and not less than the number of votes required to amend the society's bylaws. The assembly must be elected and shall meet at least once every four years and shall elect a board of directors to conduct the business of the society between meetings of the assembly. Vacancies on the board of directors between elections may be filled in the manner prescribed by the society's bylaws; or
(b) the supreme governing body is a board composed of persons elected by the members, either directly or by the representatives in intermediate assemblies, and other persons prescribed in the society's bylaws. A society may provide for election of the board by mail. Each term of a board member may not exceed four years. Vacancies on the board between elections may be filled in the manner prescribed by the society's bylaws. Those persons elected to the board shall constitute a majority in number and not less than the number of votes required to amend the society's bylaws. A person filling the unexpired term of an elected board member is considered an elected member. The board shall meet at least quarterly to conduct the business of the society;
(2) the officers of the society are elected either by the supreme governing body or by the board of directors;
(3) only benefit members are eligible for election to the supreme governing body and the board of directors; and
(4) each voting member has one vote; a vote may not be cast by proxy.
HISTORY: 2000 Act No. 259, Section 1.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 38 - Fraternal Benefit Societies › Section 38-38-40. Definitions.

Whenever used in this chapter:
(1) "Benefit contract" means the agreement for provision of benefits authorized by this chapter, as that agreement is described in this chapter.
(2) "Benefit member" means an adult member who is designated by the bylaws or rules of the society to be a benefit member under a benefit contract.
(3) "Certificate" means the document issued as written evidence of the benefit contract.
(4) "Director" means the Director of the Department of Insurance of this State.
(5) "Bylaws" means the society's articles of incorporation, constitution, and bylaws, however designated.
(6) "Lodge" means subordinate member units of the society, known as camps, courts, councils, branches, or by any other designation.
(7) "Premiums" means premiums, rates, dues, or other required contributions, by whatever name known, which are payable under the certificate.
(8) "Rules" means all rules, regulations, or resolutions adopted by the supreme governing body or board of directors which are intended to have general application to the members of the society.
(9) "Society" means fraternal benefit society, unless otherwise indicated.
HISTORY: 2000 Act No. 259, Section 1.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 38 - Fraternal Benefit Societies › Section 38-38-50. Operation for benefit of members; power to adopt bylaws and rules.

(A) A society shall operate for the benefit of members and their beneficiaries by:
(1) providing benefits as specified in Section 38-38-310; and
(2) operating for one or more social, intellectual, educational, charitable, benevolent, moral, fraternal, patriotic, or religious purposes for the benefit of its members, which also may be extended to others.
These purposes may be carried out directly by the society or indirectly through subsidiary corporations or affiliated organizations.
(B) Every society has the power to adopt bylaws and rules for the government of the society, the admission of its members, and the management of its affairs. It has the power to change, alter, add to, or amend the bylaws and rules and has other powers as are necessary and incidental to carrying into effect the objects and purposes of the society.
HISTORY: 2000 Act No. 259, Section 1.
2023 South Carolina Code of Laws › Title 38 - Insurance › Chapter 38 - Fraternal Benefit Societies › Section 38-38-110. Membership provisions in bylaws or rules.

(A) A society shall specify in its bylaws or rules:
(1) eligibility standards for each and every class of membership, provided that if benefits are provided on the lives of children, the minimum age for adult membership must be set at not less than age fifteen and not greater than age twenty-one;
(2) the process for admission to membership for each membership class; and
(3) the rights and privileges of each membership class, provided that only benefit members have the right to vote on the management of the insurance affairs of the society.
(B) A society also may admit social members who shall have no voice or vote in the management of the insurance affairs of the society.
(C) Membership rights in the society are personal to the member and are not assignable.
HISTORY: 2000 Act No. 259, Section 1.