The Vermont Statutes Online
The Statutes below include the actions of the 2025 session of the General Assembly.
NOTE: The Vermont Statutes Online is an unofficial copy of the Vermont Statutes Annotated that is provided as a convenience.
(Cite as: 8 V.S.A. § 5105)
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§ 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.)