Title 33, Chapter 21, Section 2
( 33-21-2)
(a) Any domestic stock, mutual, or nonprofit corporation whose
charter powers include the business of a health maintenance
organization may apply to the Commissioner for and obtain a
certificate of authority to establish and operate a health
maintenance organization in compliance with this chapter. No person
shall establish or operate a health maintenance organization in this
state; sell, offer to sell, or solicit offers to purchase; or
receive advance or periodic consideration in conjunction with a
health maintenance organization without obtaining a certificate of
authority under this chapter. (b) Each application for a certificate of authority shall be
verified by an officer or authorized representative of the
applicant, shall be in a form prescribed by the Commissioner, and
shall set forth or be accompanied by the following: (1) A copy of the corporation's charter and all amendments to the
charter; (2) A copy of the bylaws, rules and regulations, or similar
document, if any, regulating the conduct of the internal affairs
of the applicant; (3) A list of the names, addresses, and official positions of the
persons who are to be responsible for the conduct of the affairs
of the applicant, including all members of the board of directors,
board of trustees, executive committee, or other governing board
or committee, and the principal officers of the corporation; (4) A copy of any contract made or to be made between any
providers or persons listed in paragraph (3) of this subsection
and the applicant; (5) A statement describing in detail the health maintenance
organization, its health benefits plan or plans, facilities, and
personnel; (6) A copy of the form of evidence of coverage to be issued to the
enrollees; (7) A copy of the form of the group contract, if any, which is to
be issued to employers, unions, trustees, or other organizations; (8) Financial statements showing the applicant's assets,
liabilities, and sources of financial support. If the applicant's
financial affairs are audited by independent certified public
accountants, a copy of the applicant's most recent regular
certified financial statement shall be deemed to satisfy this
requirement unless the Commissioner directs that additional or
more recent financial information is required for the proper
administration of this chapter; (9) A description of the proposed method of marketing the plan, a
financial plan which includes a three-year projection of the
initial operating results anticipated, and a statement as to the
sources of working capital as well as any other sources of
funding;
(10) A power of attorney duly executed by such applicant, if not
domiciled in this state, appointing the Commissioner, his
successors in office, and duly authorized deputies as the true and
lawful attorney of the applicant in and for this state upon whom
all lawful process in any legal action or proceeding against the
health maintenance organization on a cause of action arising in
this state may be served; (11) A statement describing the geographic area or areas to be
served; (12) A description of the complaint procedures to be utilized as required under Code Section 33-21-9; (13) A description of the procedures and programs to be implemented to meet the quality of health care requirements in subsection (b) of Code Section 33-21-3; (14) A description of the mechanism by which enrollees will be afforded an opportunity to participate in matters of policy and operation under subsection (b) of Code Section 33-21-6; and (15) Such other information as the Commissioner may require. (c)(1) A health maintenance organization shall, unless otherwise
provided for in this chapter, file a notice describing any
modification of the operation set out in the information required
by subsection (b) of this Code section. Such notice shall be
filed with the Commissioner prior to the modification. If the
Commissioner does not disapprove within 60 days of filing, such
modification shall be deemed approved. (2) The Commissioner may promulgate rules and regulations
exempting from the filing requirements of paragraph (1) of
subsection (b) of this Code section those items he deems
unnecessary. |