(a)An application for a certificate of authority
to operate a limited service health maintenance organization must be
filed with the commissioner on a form prescribed by the commissioner.
An application must be verified by an officer or authorized
representative of the applicant and must set forth, or be accompanied
by, the following:
(1)A copy of the applicant's basic organizational document, such
as the articles of incorporation, articles of association, partnership
agreement, trust agreement, articles of organization, or other
applicable documents, and all amendments to those documents.
(2)A copy of all bylaws, rules and regulations, or similar
documents, if any, regulating the conduct of the internal affairs of
the applicant.
(3)A list of the names, addresses, official positions, a
Free access — add to your briefcase to read the full text and ask questions with AI
(a) An application for a certificate of authority
to operate a limited service health maintenance organization must be
filed with the commissioner on a form prescribed by the commissioner.
An application must be verified by an officer or authorized
representative of the applicant and must set forth, or be accompanied
by, the following:
(1) A copy of the applicant's basic organizational document, such
as the articles of incorporation, articles of association, partnership
agreement, trust agreement, articles of organization, or other
applicable documents, and all amendments to those documents.
(2) A copy of all bylaws, rules and regulations, or similar
documents, if any, regulating the conduct of the internal affairs of
the applicant.
(3) A list of the names, addresses, official positions, and
biographical information of the individuals who are to be
responsible for conducting the affairs and daily operations of the
applicant, including the following:
(A) All members of the board of directors, board of trustees,
executive committee, or other governing board or committee.
(B) The principal officers.
(C) Any person or entity owning or having the right to acquire
at least ten percent (10%) of the voting securities of the
applicant.
(D) In the case of a partnership or an association, the partners
or members of the partnership or association.
(E) In the case of a limited liability company, the managers or
members of the limited liability company.
(4) A statement generally describing the applicant, the facilities
and personnel of the applicant, and the limited health service or
services that the applicant will offer.
(5) A copy of the form of any contract that has been made or is to
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 that has been made or is to
be made between the applicant and any person referred to in
subdivision (3).
(7) A copy of the form of any contract that has been made or is to
be made between the applicant and any person, corporation,
partnership, or other entity for the performance of any functions
on behalf of the applicant, including the following:
(A) Marketing.
(B) Administration.
(C) Enrollment.
(D) Investment management.
(E) Subcontracting for the provision of limited health services
to enrollees.
(8) A copy of the form of any contract that is to be issued to
employers, unions, trustees, or other organizations or individuals,
and a copy of any form of evidence of coverage to be issued to
subscribers.
(9) Subject to subsection (b), a copy of the most recent financial
statements of the applicant, audited by an independent certified
public accountant.
(10) A copy of the financial plan of the applicant, including:
(A) a projection of anticipated operating results for at least
three (3) years; and
(B) a statement of the sources of working capital and any other
sources of funding and provisions for contingencies.
(11) A description of the proposed method of marketing.
(12) A statement acknowledging that all lawful process in any
legal action or proceeding against the applicant on a cause of
action arising in Indiana is valid if served in accordance with the
Indiana Rules of Trial Procedure.
(13) A description of the complaint procedures to be established
and maintained under IC 27-13-10.
(14) A description of the quality assessment and utilization review
procedures to be used by the applicant.
(15) A description of how the applicant will comply with sections
16 and 17 of this chapter.
(16) The fee for the issuance of a certificate of authority required
by section 23 of this chapter.
(17) A written waiver of the applicant's rights under federal
bankruptcy laws.
(18) Other information that the commissioner reasonably requires
to make the determinations required by this chapter.
(19) If the applicant is not domiciled in Indiana, an executed
power of attorney appointing the commissioner, the
commissioner's successors in office, and authorized deputies of
the commissioner as the true and lawful attorney of the applicant
in and for Indiana upon whom all lawful process in any legal
action or proceeding against the limited service health
maintenance organization on a cause of action arising in Indiana
may be served.
(b) If the financial affairs of the parent company of the applicant are
audited by independent certified public accountants but those of the
applicant are not, an applicant may satisfy the requirement set forth in
subsection (a)(9) by including with the application the most recent
audited financial statement of the applicant's parent company, certified
by an independent certified public accountant, attached to which shall
be consolidating financial statements of the applicant, unless the
commissioner determines that additional or more recent financial
information is required for the proper administration of this chapter.