§ 26.1-17.1-04 — Issuance of certificate of authority - Denial

North Dakota § 26.1-17.1-04

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-17.1: Prepaid Limited Health Service Organizations

Text

1. Following receipt of an application filed pursuant to section 26.1-17.1-03, the
commissioner shall review such application and notify the applicant of any
deficiencies. The commissioner shall issue a certificate of authority to an applicant
provided that the following conditions are met:
a. The requirements of section 26.1-17.1-03 have been fulfilled.
b. The individuals responsible for conducting the applicant's affairs are competent,
trustworthy, and possess good reputations, and have had appropriate experience,
training, or education.
c. The applicant is financially responsible and may reasonably be expected to meet
its obligations to enrollees and to prospective enrollees. In making this
determination, the commissioner may consider:
(1) The financial soundness of the applicant's arrangements for limited health
services and the minimum standard rates, deductibles, copayments, and
other patient charges used in connection therewith.
(2) The adequacy of working capital, other sources of funding, and provisions
for contingencies.
(3) Any agreement for paying the cost of the limited health services or for
alternative coverage in the event of insolvency of the prepaid limited health
service organization.
(4) The manner in which the requirements of section 26.1-17.1-17 have been
fulfilled.
d. The agreements with providers for the provision of limited health services contain
the provisions required by section 26.1-17.1-16.
e. Any deficiencies identified by the commissioner have been corrected.
2. If the certificate of authority is denied, the commissioner shall notify the applicant and
shall specify the reasons for denial in the notice. The applicant has thirty days from the
date of receipt of the notice to request a hearing before the commissioner pursuant to
chapter 28-32.