Certificate of authority; exception for corporate employee programs; applications; material modification of operation.
(a)No organization shall establish or operate a limited health service organization in this State without obtaining and maintaining a certificate of authority under this Act. No person other than an organization may lawfully establish or operate a limited health service organization in this State. This Act shall not apply to the establishment and operation of a limited health service organization exclusively providing or arranging for limited health services to employees of a corporate affiliate of such limited health service organization. This exclusion shall be available only to those limited health service organizations which require employee contributions which equal
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Certificate of authority; exception for corporate employee programs; applications; material modification of operation. (a) No organization shall establish or operate a limited health service organization in this State without obtaining and maintaining a certificate of authority under this Act. No person other than an organization may lawfully establish or operate a limited health service organization in this State. This Act shall not apply to the establishment and operation of a limited health service organization exclusively providing or arranging for limited health services to employees of a corporate affiliate of such limited health service organization. This exclusion shall be available only to those limited health service organizations which require employee contributions which equal less than 50% of the total cost of the limited health care plan, with the remainder of the cost being paid by the corporate affiliate which is the employer of the participants in the plan. (b) Any organization may apply to the Director for and obtain a certificate of authority to establish and operate a limited health service organization in compliance with this Act. A foreign corporation may qualify under this Act, subject to its obtaining and maintaining authorization to do business in this State as a foreign corporation. (c) Each application for certificate of authority shall be filed in triplicate and verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the Director, and shall set forth, without limiting what may be required by the Director, the following: (1) A copy of the organization document. (2) A copy of the bylaws, rules and regulations, or similar document 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 but not limited to, all members of the board of directors, executive committee, the principal officers, and any person or entity owning or having the right to acquire 10% or more of the voting securities or subordinated debt of the applicant. (4) A statement generally describing the application, geographic area to be served, its facilities, personnel and the limited health service or services to be offered. (5) A copy of the form of any contract made or be made between the applicant and any providers regarding the provision of limited health services to enrollees. (6) A copy of the form of any contract made, or to be made between the applicant and any person listed in paragraph (3) of this subsection. (7) A copy of the form of any contract made or to be made between the applicant and any person, corporation, partnership or other entity for the performance on the applicant's behalf of any functions including, but not limited to, marketing, administration, enrollment, investment management and subcontracting for the provision of limited health services to enrollees. (8) A copy of the form of any group contract which is to be issued to employers, unions, trustees or other organizations and a copy of any form of evidence of coverage to be issued to any enrollee or subscriber and any advertising material. (9) A copy of the applicant's most recent financial statements audited by an independent certified public accountant. If the financial affairs of the applicant's parent company are audited by an independent certified public account, but those of the applicant are not, then a copy of the most recent audited financial statement of the applicant's parent, attached to which shall be consolidating financial statements of the parent including separate unaudited financial statements of the applicant, unless the Director determines that additional or more recent financial information is required for the proper administration of this Act. (10) A copy of the applicant's financial plan, including a 3 year projection of anticipated operating results, a statement of the sources of working capital and any other sources of funding and provisions for contingencies. (11) A description of rate methodology. (12) A description of the proposed method of marketing. (13) Except in the case of a foreign applicant authorized to transact business in this State, a statement acknowledging that all lawful process in any legal action or proceeding against the applicant on a cause of action arising in this State is valid if served in accordance with Section 112 of the Illinois Insurance Code as now or hereafter amended. (14) A description of the complaint procedures to be established and maintained as required under Section 3002 of this Act. (15) A description of the quality assessment and utilization review procedures to be utilized by the applicant. (16) The fee for filing an application for issuance of a certificate of authority provided in Section 408 of the Illinois Insurance Code as now or hereafter amended. (17) Such other information as the Director may reasonably require to make the determinations required by this Act.