The admitted assets of domestic and foreign HMOs must at all
times comply with the provisions of this section.
(1) Investment of minimum net worth. An HMO must have
a minimum net worth as required by §11.802 of this title (relating
to Minimum Net Worth).
(2) Investment of assets supporting uncovered medical
expenses. An HMO must maintain statutory deposits supporting uncovered
medical expenses as required by §11.803 of this title (relating
to Statutory Deposit Requirements).
(3) Investments of assets in excess of minimum net
worth and uncovered medical expenses. An HMO may invest its funds
in excess of minimum net worth and uncovered medical expenses only
in the following:
(A) any investments allowed in paragraphs (1) or (2)
of this section;
(B) direct general obligations of any state of the
United States of America for the payment of money, or obligations
for the payment of money, to the extent guaranteed or insured as to
the payment of principal and interest by any state of the United States
of America, provided that:
(i) the state has the power to levy taxes for the prompt
payment of the principal and interest of the obligations; and
(ii) the state is not in default in the payment of
principal or interest on any of its direct, guaranteed, or insured
general obligations at the date of the investment;
(C) bonds, interest-bearing warrants, or other obligations
issued by authority of law by any county, city, town, school district,
or other municipality or political subdivision that is now or hereafter
may be construed or organized under the laws of any state in the United
States of America and that is authorized to issue the bonds, warrants,
or other obligations under the constitution and laws of the state
in which it is situated, provided:
(i) legal provision has been made by a tax to meet
the obligations or a special revenue or income to meet the principal
and interest payments as they accrue on the obligations has been appropriated,
pledged, or otherwise provided; and
(ii) the county, city, town, school district, or other
municipality or political subdivision is not in default in the payment
of principal or interest on any of its obligations at the date of
the investment;
(D) bonds, interest-bearing warrants, or other obligations
issued by authority of law by any educational institution that is
now or hereafter may be construed or organized under the laws of any
state of the United States of America, and that is authorized to issue
the bonds and warrants under the constitution and laws of the state
in which it is situated, provided:
(i) legal provision has been made by a tax to meet
the obligations or a special revenue or income to meet the principal
and interest payments as they accrue on the obligations has been appropriated,
pledged, or otherwise provided; and
(ii) the educational institution is not in default
in the payment of principal or interest on any of its obligations
at the date of the investment;
(E) investments issued by insurers or HMOs subject
to the following conditions:
(i) an HMO may not make an investment under this subparagraph
in any other HMO or insurer unless the other HMO or insurer is duly
licensed to do business in its domestic state and at the time of the
investment is in compliance with the minimum capital and surplus requirements
then applicable under the provisions of that state's statutes and
regulations; however, an HMO may make an investment under this paragraph
in another HMO that has not yet received its certificate of authority
to conduct the business of an HMO in its domestic state or that does
not yet possess the minimum capital and surplus required by its domestic
state if the investment will be sufficient to give the investing HMO
at least 50 percent control in the other HMO;
(ii) an HMO may not invest, except as provided in subparagraphs
(F) and (G) of this paragraph, in any other HMO or insurer unless
the investments will result, within 180 days of the first investment,
in the investing HMO having control in the other HMO or insurer;
(iii) an HMO may not invest more than 50 percent of
its net worth in excess of minimum net worth in any other HMO or insurer;
(iv) the total investments made by an HMO in all other
HMOs or insurers under this subparagraph may not exceed 75 percent
of the investing HMO's net worth in excess of minimum net worth; and
(v) the restrictions of clauses (iii) and (iv) of this
subparagraph do not apply if the HMO is purchasing 100 percent of
the stock of another HMO for the purpose of a merger anticipated to
take place no later than three months from the purchase date, unless
the period is extended by the commissioner, and the resulting assets
of the surviving HMO meet the requirements set forth in this subchapter
within three months after the merger, unless the period is extended
by the commissioner;
(F) bonds, debentures, bills of exchange, commercial
notes, or any other bills and obligations of any corporation, incorporated
under the laws of any state of the United States of America or of
the United States of America, that, at the time of investment, is
designated highest quality (NAIC designation 1) or high quality (NAIC
designation 2) in compliance with the guidance provided by the NAIC
Valuation of Securities Manual;
(G) equity interests, including common stocks issued
by any business entity created under the laws of the United States
of America or of any state of the United States, provided that:
(i) the business entity is solvent, with a net worth
of at least $1 million;
(ii) if the business entity is a dividend paying business
entity, no cumulative dividends are in arrears;
(iii) an HMO may not invest in a partnership, as a
general partner, except through a wholly owned subsidiary; and
(iv) the restrictions of clauses (i) and (ii) of this
subparagraph do not apply if the business entity of which the HMO
wishes to purchase the equity interest is, or is to be, a contracted
provider of services;
(H) shares of mutual funds doing business under the
Investment Company Act of 1940 (15 United States Code §80a-1,
et seq.) and shares in real estate investment trusts as defined in
Internal Revenue Code of 1986 (26 United States Code §856), provided
that the mutual funds and real estate investment trusts be solvent
with at least $1 million of net assets as of the date of its latest
annual, or more recent, certified audited financial statement;
(I) mortgage loans by an HMO that are secured by valid
first liens on improved real estate, provided that:
(i) there is a title insurance policy or attorney's
opinion showing that the borrower owns the real estate;
(ii) there is an appraisal of the real estate and its
improvements and the loan does not exceed 75 percent of the appraised
value;
(iii) there is an executed note evidencing the loan;
(iv) there is a recorded deed of trust;
(v) the value of the improvements is adequately insured
by a company authorized to do business in Texas or in the state in
which the real estate is located, and the insurance policy is made
payable to the HMO in an amount equal to at least 50 percent of the
value of the building, but the insurance coverage need not exceed
the outstanding balance owed to the HMO when the outstanding balance
falls below 50 percent of the value of the building; and
(vi) the commissioner has the right to obtain an independent
appraisal, at the HMO's expense, of real estate securing any loan;
(J) loans secured by collateral, of a nature specified
in Insurance Code §843.403 (concerning Minimum Net Worth) and §11.802
of this title (relating to Minimum Net Worth), although the amount
loaned may not exceed the value of the securities held as collateral;
(K) loans, whether secured or unsecured and that are
not in default, to medical and other health care providers under contract
with the HMO for the provision of health care services; however, the
admitted value of any loan made under this subparagraph may not exceed
the maker's ability to repay the loan, which is calculated by only
considering assets that an HMO may hold toward determining any excess
of assets over all liabilities of the maker;
(L) real estate acquired in satisfaction of debt; all
real property not qualifying under any other provisions of this section
must be sold and disposed of within five years after the HMO has acquired
title unless the time for disposal is extended by the commissioner;
(M) investments in improved, income-producing real
estate;
(N) additional investments that are not otherwise specified
by this section, provided that:
(i) the amount of any one investment may not exceed
10 percent of the net worth in excess of the HMO's minimum net worth
plus uncovered medical expenses at the time of investment; and
Cont'd... |
