TITLE 41

INSURANCE

CHAPTER 34

HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS

41-3408.  Qualifications for certificate of authority. The director shall not issue or permit to exist a certificate of authority to be or act as a service corporation, as to any corporation not fulfilling the following qualifications:

(1)  Must be incorporated as provided in section 41-3406, Idaho Code, as a professional service corporation.

(2)  Must intend to and actually conduct its business in good faith as a nonprofit corporation.

(3)  Must have in force service agreements with participant licensees located in the areas of the subscribers’ residences convenient as to location and sufficient in numbers, capacity and facilities reasonably to furnish respective categories of health care services then provided or proposed to be provided by the corporation to its subscribers. Said professional service corporation shall be ready and willing at all times to enter into service agreements with all licensees of the category or categories specified in its articles of incorporation who are qualified under the laws of the state of Idaho and who desire to become participant licensees of said corporation and who practice within the general area served by said professional service corporation.

(4)  If a newly formed corporation, it must possess sufficient available working funds to pay all reasonably anticipated cost of acquisition of new business and operating expenses, other than payment for professional services, for a period of not less than the six (6) months next following the date of issuance of the certificate of authority, if issued.

(5)  Nothing in this section shall preclude a service corporation from refusing to contract with a health care licensee who is unqualified or who does not meet the terms and conditions of the participating licensee contract of the service corporation or from terminating or refusing to renew the contract of a participating health care licensee who is unqualified or who does not comply with, or who refuses to comply with, the terms and conditions of the participating health care licensee contract including, but not limited to, practice standards and quality requirements. The contract shall provide for written notice to the participating health care licensee setting forth any breach of contract for which the service corporation proposes that the contract be terminated or not renewed and shall provide for a reasonable period of time for the participating health care licensee to cure such breach prior to termination or nonrenewal. If the breach has not been cured within such period of time the contract may be terminated or not renewed. Provided however, that if the breach of contract for which the service corporation proposes that the contract be terminated or not renewed is a willful breach, fraud or a breach which poses an immediate danger to the public health or safety, the contract may be terminated or not renewed immediately.

(6)  Every service corporation issuing benefits pursuant to this chapter shall establish a grievance system for licensees. Such grievance system shall provide for arbitration according to chapter 9, title 7, Idaho Code, or for such other system which provides reasonable due process provisions for the resolution of grievances and the protection of the rights of the parties.

(7)  Must fulfill all other applicable requirements of this chapter.

History:

[41-3408, added 1961, ch. 330, sec. 766, p. 645; am. 1965, ch. 46, sec. 2, p. 70; am. 1967, ch. 91, sec. 2, p. 194; am. 1967, ch. 399, sec. 4, p. 1194; am. 1969, ch. 36, sec. 4, p. 86; am. 1971, ch. 252, sec. 4, p. 1008; am. 1994, ch. 78, sec. 4, p. 179; am. 1994, ch. 275, sec. 2, p. 854; am. 2007, ch. 90, sec. 22, p. 259.]