TITLE 41

INSURANCE

CHAPTER 39

MANAGED CARE REFORM

41-3906.  Application for certificate of authority. (1) The application for a certificate of authority shall be in writing in the form prescribed by the director. It shall be verified by an officer of an applicant corporation or association, or member of an applicant firm, or by the applicant if an individual. The application shall set forth or be accompanied by:

(a)  a copy of the basic organizational document of the applicant, such as articles of incorporation or of association, partnership agreement, trust agreement, or other applicable documents, and all amendments thereto;

(b)  a copy of the bylaws, rules, or similar document regulating conduct of the applicant’s internal affairs;

(c)  a listing of the names, addresses, principal occupations, and official positions of the individuals who are to be responsible for the conduct of applicant’s affairs, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers in the case of a corporation, and the partners or members in the case of a partnership or association;

(d)  a copy of any contract made or to be made between the applicant and any provider, and the applicant and any person named in subsection (c) hereof;

(e)  a statement generally describing the managed care organization, its health care plan or plans, facilities, and personnel;

(f)  a copy of each form of health care contract proposed to be issued;

(g)  financial statements showing the applicant’s audited assets, liabilities, and sources and amount of financial support. A copy of the applicant’s most recent regular certified financial statement shall be deemed to satisfy this requirement unless the director directs that additional or more recent financial information is required for proper administration of this chapter;

(h)  a financial plan, which includes a three (3) year projection of initial operating results anticipated, and a statement as to the sources of working capital as well as any other source of funding;

(i)  a description of the proposed method of marketing the plan;

(j)  a statement of the geographic area or areas to be served;

(k)  a description of the grievance procedures as required under section 41-3918, Idaho Code;

(l)  a description of the system and procedures for monitoring the quality of health care services as required by section 41-3905(6)(a), Idaho Code;

(m)  a description of the mechanism by which members will be given an opportunity to participate in matters of policy and operation as required by section 41-3916, Idaho Code;

(n)  if the applicant is not domiciled in this state, a power of attorney duly executed by the applicant and irrevocably appointing the director and his successors in office as the applicant’s attorney upon whom may be served all lawful process in any legal action or proceeding against the managed care organization on a cause of action arising in this state; and

(o)  such other information as the director may reasonably require as to the applicant’s qualifications as a managed care organization.

(2)  Every organization authorized to offer a managed care plan under a certificate of authority issued prior to July 1, 1997, shall comply with any new or additional requirements, other than applicable capital, surplus and deposit requirements, imposed by this act by January 1, 1998. If the organization does not comply by January 1, 1998, the organization shall no longer be authorized to offer managed care plans on a predetermined and prepaid basis in this state.

History:

[41-3906, added 1974, ch. 177, sec. 6, p. 1444; am. 1980, ch. 197, sec. 31, p. 455; am. 1997, ch. 204, sec. 8, p. 587.]