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<section article="ghg" article_name="Health - General" number="15-102.4" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs">
  <level label="a">
    <level label="1">
      <text>Each managed care organization shall be actuarially sound.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>Except as otherwise provided in this section, the surplus that a managed care organization is required to have shall be paid in full.</text>
      </level>
      <level label="ii">
        <text>A managed care organization shall have an initial surplus that exceeds the liabilities of the managed care organization by at least $1,500,000.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>In consultation with the Secretary, the Insurance Commissioner may adjust the initial surplus requirement for a managed care organization that is not licensed as a health maintenance organization. In determining whether to make an adjustment under this paragraph, the Commissioner shall consider:</text>
      <level label="i">
        <text>The proposed capitation level that would be received by the managed care organization under a contract with the Department under this subtitle;</text>
      </level>
      <level label="ii">
        <text>The proposed range of benefits to be provided under a contract with the Department under this subtitle;</text>
      </level>
      <level label="iii">
        <text>The existence of any commitment by the Secretary to designate funds over and above the proposed capitation where the designated funds:</text>
        <level label="1">
          <text>Are equivalent to the difference between the requirements of § 19–710 of this article and any lower requirements determined by the Commissioner under this subparagraph; and</text>
        </level>
        <level label="2">
          <text>Would be available in case of the impairment or insolvency of the managed care organization; and</text>
        </level>
      </level>
      <level label="iv">
        <text>The availability of the money held in trust by the Secretary to pay claims in case of impairment or insolvency of the managed care organization.</text>
      </level>
    </level>
    <level label="2">
      <text>Notwithstanding subsection (a)(2)(ii) of this section, a managed care organization shall have an initial surplus that exceeds liabilities by at least $1,250,000. If a managed care organization has an initial surplus that is at least $1,250,000 but less than $1,500,000, prior to approval, the Department shall designate funds under paragraph (1)(iii) of this subsection sufficient to provide an initial surplus of at least $1,500,000.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <level label="i">
        <text>Each managed care organization shall maintain a surplus that exceeds the liabilities of the managed care organization in the amount that is at least equal to the greater of $750,000 or 5 percent of the subscription charges earned during the prior calendar year as recorded in the annual report filed by the managed care organization with the Commissioner.</text>
      </level>
      <level label="ii">
        <text>No managed care organization shall be required to maintain a surplus in excess of a value of $3,000,000.</text>
      </level>
    </level>
    <level label="2">
      <level label="i">
        <text>For the protection of the managed care organization’s enrollees and creditors, the applicant shall deposit and maintain in trust with the State Treasurer $100,000 in cash or government securities of the type described in § 5–701(b) of the Insurance Article.</text>
      </level>
      <level label="ii">
        <level label="1">
          <text>The deposits shall be accepted and held in trust by the State Treasurer in accordance with the provisions of Title 5, Subtitle 7 of the Insurance Article.</text>
        </level>
        <level label="2">
          <text>For the purpose of applying this subparagraph, a managed care organization shall be treated as an insurer.</text>
        </level>
      </level>
    </level>
  </level>
  <level label="d">
    <text>Each managed care organization shall comply with risk based capital standards in accordance with regulations adopted by the Insurance Commissioner under § 4–311 of the Insurance Article.</text>
  </level>
</section>
