Guidelines on the Issuance of CDOs against HMOs
Insurance Circular Letter No. 2019-28 outlines the guidelines for issuing Cease and Desist Orders (CDOs) against Health Maintenance Organizations (HMOs) in the Philippines. The Insurance Commissioner has the authority to issue these orders to prevent fraud and harm to HMO members and the public, either on their own initiative or in response to verified complaints. The order can be issued without a prior hearing if deemed necessary, and the details of the investigation remain confidential until the order is made public. HMOs have the right to request a hearing to lift the CDO within five days of receipt. The Circular is effective immediately and repeals any conflicting regulations.
Quick Answers
- What is Guidelines on the Issuance of CDOs against HMOs about?
- Insurance Circular Letter No. 2019-28 outlines the guidelines for issuing Cease and Desist Orders (CDOs) against Health Maintenance Organizations (HMOs) in the Philippines. The Insurance Commissioner has the authority to issue these orders to prevent fraud and harm to HMO members and the public, either on their own initiative or in response to verified complaints. The order can be issued without a prior hearing if deemed necessary, and the details of the investigation remain confidential until the order is made public. HMOs have the right to request a hearing to lift the CDO within five days of receipt. The Circular is effective immediately and repeals any conflicting regulations.
- What type of law is Insurance Circular Letter No. 2019-28?
- Guidelines on the Issuance of CDOs against HMOs (Insurance Circular Letter No. 2019-28) is a Philippine Other Rules and Procedures enacted by the Congress of the Philippines.
- When was Guidelines on the Issuance of CDOs against HMOs enacted?
- Guidelines on the Issuance of CDOs against HMOs (Insurance Circular Letter No. 2019-28) was enacted on Jun 21, 2019.
- What is the citation for Guidelines on the Issuance of CDOs against HMOs?
- Guidelines on the Issuance of CDOs against HMOs, Insurance Circular Letter No. 2019-28, Jun 21, 2019 (Philippines)
Law Information
- Reference Number
- Insurance Circular Letter No. 2019-28
- Date Enacted
- Category
- Other Rules and Procedures
- Subcategory
- Insurance
- Jurisdiction
- Philippines
- Enacting Body
- Congress of the Philippines
Full Law Text
June 21, 2019
INSURANCE CIRCULAR LETTER NO. 2019-28
| TO | : | All Health Maintenance Organizations |
| SUBJECT | : | Guidelines on the Issuance of Cease and Desist Orders (CDOs) against Health Maintenance Organizations (HMOs) |
Pursuant to the powers granted to the Insurance Commissioner to issue orders to prevent fraud and injury to the HMO plan holders and industry stakeholders under Section 4 (e) of Executive Order No. 192, s. 2015 dated 12 November 2015, the Commission hereby promulgates this guidelines pertaining to the issuance of cease and desist orders against insurance companies and health maintenance organizations (HMOs).
SECTION 1. Scope. —
This Circular shall govern the issuance of the Insurance Commission of Cease and Desist Orders (CDOs) against health maintenance organizations (HMOs).
SECTION 2. Issuance of Cease and Desist Order. —
The Commission may, after proper investigation or verification, motu proprio, or upon verified complaint by any aggrieved party, issue a cease and desist order without the necessity of a prior hearing if in its judgment the act or practice, unless restrained, will operate as a fraud on HMO members, or otherwise likely to cause grave or irreparable injury or prejudice to the public.
Until the Commission issues a cease and desist order, the fact that an investigation has been initiated or that a complaint has been filed, including the contents of the complaint, shall be confidential. Upon issuance of a cease and desist order, the Commission shall make public such order and a copy thereof shall be immediately furnished to each person subject to the order. CAIHTE
SECTION 3. Lifting of Cease and Desist Order. —
Any HMO company against whom a Cease and Desist order was issued may, within five (5) days from receipt of the order, file a formal request for lifting thereof. Said request shall be set for hearing by the Commission not later than fifteen (15) days from its filing and the resolution thereof shall be made not later than ten (10) days from the termination of the hearing.
SECTION 4. Separability Clause. —
Should any provision of this Circular or any part thereof be declared invalid, the other provisions, insofar as they are separable from the invalid ones, shall remain in full force and effect.
SECTION 5. Repealing and Amending Clause. —
All Orders, Rules and Regulations, Memoranda and other issuances inconsistent with or contrary to the provisions of this Circular are hereby repealed/amended accordingly.
SECTION 6. Effectivity. —
This Circular shall be effective immediately. DETACa
(SGD.) DENNIS B. FUNAInsurance Commissioner
Cite This Law
Guidelines on the Issuance of CDOs against HMOs, Insurance Circular Letter No. 2019-28, Jun 21, 2019 (Philippines)
Guidelines on the Issuance of CDOs against HMOs, Insurance Circular Letter No. 2019-28 (Phil. 2019)
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