NAC695C.136. Contract of insurance for provider-sponsored organization: Amount determined by Commissioner; provision concerning insolvency of organization; notice of cancellation.

     1. A provider-sponsored organization shall obtain a contract of insurance for the cost of providing a Medicare + Choice plan which exceeds, per enrollee, an amount to be determined by the Commissioner.

     2. The contract of insurance may have an aggregate limit in an amount to be determined by the Commissioner. Subject to that aggregate limit, the contract of insurance must:

     (a) Include a provision which states that, in case of the insolvency of the provider-sponsored organization, the insurer will pay all claims made by an enrollee for the period during which a premium was paid to the provider-sponsored organization.

     (b) Specifically provide for:

          (1) The continuation of benefits to enrollees for the period during which prepayments were made to the provider-sponsored organization;

          (2) The continuation of benefits for enrollees confined in a medical facility or facility for the dependent at the time of the insolvency of the provider-sponsored organization until the enrollee is discharged from the facility; and

          (3) The payment of a provider who is not affiliated with the provider-sponsored organization and who provided medically necessary services, as described in the evidence of coverage, to an enrollee during the time in which payments were made to the provider-sponsored organization.

     3. A contract of insurance obtained by a provider-sponsored organization pursuant to this section must not be cancelled unless the provider-sponsored organization and insurer provide the Commissioner with written notice at least 90 days before the cancellation.

     (Added to NAC by Comm’r of Insurance by R148-99, eff. 1-27-2000)