1. No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which
is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive.
For purposes of this chapter:
A. A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or
may be significant to an enrollee of, or person considering enrollment in, a health maintenance organization; [1975, c. 503, (NEW).]
B. A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the
total context in which such statement is made or such item of information is communicated, such statement or item of information
may be reasonably understood by a reasonable person, not possessing special knowledge regarding health care coverage, as indicating
any benefit or advantage or the absence of any exclusion, limitation or disadvantage of possible significance to an enrollee
of, or person considering enrollment in, a health maintenance organization, if such benefit or advantage or absence of limitation,
exclusion or disadvantage does not in fact exist; [1975, c. 503, (NEW).]
C. An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration
given to typography and format, as well as language, shall be such as to cause a reasonable person, not possessing special
knowledge regarding health maintenance organizations and evidences of coverage therefor, to expect benefits, services, charges
or other advantages which the evidence of coverage does not provide or which the health maintenance organization issuing such
evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage. [1975, c. 503, (NEW).]
[
1975, c. 503, (NEW)
.]
2. An enrollee may not be cancelled nor denied renewal except for the following:
A. Fraud or material misrepresentation; [1995, c. 332, Pt. O, §6 (NEW).]
B. Failure to pay the charge for coverage; [1995, c. 332, Pt. O, §6 (NEW).]
C. When the provisions of the State's community rating law are applicable, as provided by section 2736-C, subsection 3, paragraph
B and section 2808-B, subsection 4, paragraph B; or [1995, c. 332, Pt. O, §6 (NEW).]
D. Other reasons promulgated by the superintendent. [1995, c. 332, Pt. O, §6 (NEW).]
[
1995, c. 332, Pt. O, §6 (RPR)
.]
3. No health maintenance organization, unless licensed as an insurer, may use in its name, contracts or literature any of the
words "insurance", "casualty", "surety", "mutual" or any other words descriptive of the insurance, casualty or surety business
or deceptively similar to the name or description of any insurance or surety corporation doing business in this State.
[
1975, c. 503, (NEW)
.]
SECTION HISTORY
1975, c. 503, (NEW).
1995, c. 332, §O6 (AMD).
Data for this page extracted on 11/09/2009 11:20:25.