§ 14-405

(a) An applicant for a certificate of authority shall:

(1) file with the Commissioner an application, verified by an officer or authorized representative of the dental plan organization, on the form that the Commissioner provides; and

(2) pay to the Commissioner an application fee of $200.

(b) An application for a certificate of authority shall include:

(1) the basic organizational documents of the dental plan organization, including the articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, and shareholder agreement;

(2) all amendments to the organizational documents of the dental plan organization;

(3) the bylaws, rules and regulations, or similar documents that regulate the conduct or internal affairs of the dental plan organization;

(4) the names, addresses, and official positions of the individuals who are responsible for conducting the affairs of the dental plan organization, including:

(i) the members of the board of directors, board of trustees, executive committee, or other governing board or committee;

(ii) for a corporation, the principal officers; and

(iii) for a partnership or association, the partners or members;

(5) each contract made between a dentist and the dental plan organization;

(6) each contract made between a dentist and an individual listed in item (4) of this subsection, a consultant, or a business manager;

(7) a description of the dental plan organization and its dental plan or plans, facilities, and personnel;

(8) the form of evidence of coverage to be issued to enrollees;

(9) the form of each group contract that is issued to employers, unions, trustees, or others;

(10) a financial statement that details the assets, liabilities, and sources of financial support for the dental plan organization or, if the financial affairs are audited by an independent certified public accountant, a copy of the most recent regular certified financial statement, unless the Commissioner determines that additional or more recent financial information is required for the proper administration of this subtitle;

(11) the proposed method of marketing the dental plan, a financial plan with a 3-year projection of the initial operating results, and a statement of the sources of working capital and any other sources of funding;

(12) if a dental plan organization is not domiciled in the State, an executed power of attorney that appoints the Commissioner as attorney for service of process issued against the dental plan organization in the State;

(13) a description of the geographic area to be served by the dental plan organization; and

(14) any other information that the Commissioner requires.