§33-25A-11. Open enrollment period.
(1) Once a health maintenance organization has been in
operation at least five years, or has enrollment of not less than
fifty thousand persons, the health maintenance organization shall,
in any year following a year in which the health maintenance
organization has achieved an operating surplus, maintain an open
enrollment period of at least thirty days during which time the
health maintenance organization shall, within the limits of its
capacity, accept individuals in the order in which they apply
without regard to preexisting illness, medical conditions or degree
of disability except for individuals who are confined to an
institution because of chronic illness or permanent injury:
Provided, That no health maintenance organization shall be required
to continue an open enrollment period after such time as enrollment
pursuant to the open enrollment period is equal to three percent of
the health maintenance organization's net increase in enrollment
during the previous year.
(2) Where a health maintenance organization demonstrates to
the satisfaction of the commissioner that it has a disproportionate
share of high-risk enrollees and that, by maintaining open
enrollment, it would be required to enroll so disproportionate a
share of high-risk enrollees as to jeopardize its economic
viability, the commissioner may:
(a) Waive the requirement for open enrollment for a period of
not more than three years; or
(b) Authorize the organization to impose any underwriting
restrictions upon open enrollment as are necessary: (i) To
preserve its financial stability; (ii) to prevent excessive adverse
selection by prospective enrollees; or (iii) to avoid unreasonably
high or unmarketable charges for enrollee coverage of health
services. A health maintenance organization may receive more than
one waiver or authorization.