20-115. Department jurisdiction over certain health care providers; exception; examination; disclosure

A. Any person or other entity, including a provider sponsored organization that operates under the Medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII, part C of the social security act, sections 1851 through 1859), that provides coverage in this state for medical, surgical, chiropractic, naturopathic medicine, occupational therapy, physical therapy, speech pathology, audiology, professional mental health, dental, hospital or optometric expenses, whether the coverage is by direct payment, reimbursement or otherwise, is presumed to be subject to the jurisdiction of the department unless the person or other entity shows that while providing coverage it is subject to the jurisdiction of another agency of this state, any political subdivision of this or any other state or the federal government.

B. A person or entity that provides coverage for services identified in subsection A may show that it is subject to the jurisdiction of another agency of this state, any political subdivision of this or any other state or the federal government by providing to the director the appropriate certificate, license or other document that is issued by the other governmental agency and that permits or qualifies it to provide those services.

C. Any person or entity that provides coverage in this state for services described in subsection A and is unable to show it is subject to the jurisdiction of another agency of this state, any political subdivision of this or any other state or the federal government:

1. Shall submit to an examination by the director to determine the organization and solvency of the person or the entity and to determine whether or not the person or entity is in compliance with the applicable provisions of this title.

2. Is subject to all appropriate provisions of this title regarding the conduct of its business.

D. Any production agency or administrator which advertises, sells, transacts or administers coverage in this state for services described in subsection A which is provided by any person or entity described in subsection C, if that coverage is not fully insured or otherwise fully covered by an admitted life or disability insurer, nonprofit hospital service plan or nonprofit health care plan, shall advise any purchaser, prospective purchaser or covered person of the lack of insurance or other coverage.

E. Any administrator which advertises or administers coverage in this state for services described in subsection A which is provided by any person or entity described in subsection C shall advise any production agency of the elements of the coverage including the amount of stop-loss insurance in effect.

F. This section does not apply to or prohibit a self-insured program operated by a single employer for the benefit of its employees or the employees of a wholly-owned subsidiary.