| (a) On receipt of complaints, a notice under §11.2606
of this title (relating to Reporting Requirements), or as otherwise
permitted under the Insurance Code or related rules, the department
may examine any matter relating to the financial solvency of the delegated
entity or delegated third party or the delegated entity's ability
to meet its responsibilities under the delegation agreement.
(b) The department may request documents, perform on-site
examinations, and require any other action of the delegated entity
and any delegated third party that the department determines necessary
to perform an examination under this section.
(c) A delegated entity's failure to comply with a request
under subsection (b) of this section may result in either or both:
(1) notification to the HMO that the delegated entity
is subject to penalties under the delegation agreement; or
(2) entry of an order by the commissioner to resume
or redelegate any functions delegated to the delegated entity or terminate
the agreement in its entirety.
(d) The department will issue a report to the delegated
entity and HMO on completion of the department's examination. The
report will detail the results of the examination and any corrective
actions necessary by the delegated entity or HMO.
(e) The delegated entity and the HMO must respond to
the department's report and submit a corrective action plan to the
department not later than the 30th day after the date of receipt of
the department's report.
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