Vermont § 5105 - Examinations

§ 5105. Examinations

• (a) The Commissioner shall make an examination of the affairs of any health maintenance
  organization organized or holding a certificate of authority as a health maintenance
  organization in this State as often as the Commissioner deems it necessary, but not
  less frequently than once in every three years to ensure that the financial and contractual
  obligations of the health maintenance organization are being met in accordance with
  Vermont law. The Commissioner may enlarge this three-year period to five years, provided
  the health maintenance organization is subject to a comprehensive annual audit during
  such period of a scope satisfactory to the Commissioner, by independent auditors approved
  by the Commissioner. The Commissioner shall examine a health maintenance organization
  that is organized in another state as if it were organized in this State. In lieu
  of such examination, the Commissioner may accept an examination report on the company
  as prepared by the insurance department of the company’s state of domicile. Prior
  to accepting an examination report from any foreign jurisdiction, the Commissioner
  shall determine that the examination was performed in a manner and using methods and
  criteria that are as stringent as those established for Vermont examinations. Nothing
  in this section shall restrict the Commissioner’s power to examine a health maintenance
  organization when the Commissioner deems it to be in the best interests of members
  or policyholders. (b) All financial and market conduct examinations shall be conducted pursuant to and in
  conformity with sections 3573, 3574, 3575, and 3576 of this title at the expense of the health maintenance organization and shall be conducted in accordance
  with guidelines, principles, manuals, instructions, and other procedures promulgated
  by the National Association of Insurance Commissioners, including the use of statutory
  accounting principles for financial examinations, together with any useful or necessary
  modifications or adaptation thereof required or approved by the Commissioner. Every
  health maintenance organization shall provide the Commissioner with all books and
  records relating to its operation, including books and records of any affiliate or
  subsidiary as defined in section 3681 of this title. For the purpose of examinations, the Commissioner may issue subpoenas, administer
  oaths to, and examine any person and the officers and agents of the health maintenance
  organization. (Added 1979, No. 117 (Adj. Sess.); amended 1993, No. 30, § 9, eff. May 21, 1993; 1999, No. 38, § 3, eff. May 20, 1999; 2009, No. 42, § 12; 2021, No. 105 (Adj. Sess.), § 240, eff. July 1, 2022.)