§ 4402 — Health maintenance organizations; application for certificate of authority

§ 4402. Health maintenance organizations; application for certificate\nof authority. 1. No person or groups of persons may operate a health\nmaintenance organization or issue a contract to an enrollee for\nmembership in a comprehensive health services plan without first\nobtaining a certificate of authority from the commissioner.\n 2. In order to receive such a certificate of authority, a person or\npersons, hereinafter designated as the applicant, intending to operate a\nhealth maintenance organization shall file an application for such\ncertificate on such form as the commissioner shall prescribe, and shall\nprovide to the satisfaction of the commissioner the following:\n (a) a copy of each of the basic organizational documents and\nagreements of the applicant and all participating entities, including\nall contracts and agreements relating to the provision of comprehensive\nhealth services;\n (b) a copy of the bylaws, rules and regulations on internal governing\ndocuments of the applicant;\n (c) a list of the names, addresses and official positions of the\npersons comprising the applicant and all entities referred to in\nparagraph (a) other than those possessing a valid operating certificate\nunder the provisions of article twenty-eight of this chapter, including\nall owners of record or beneficial, all members of the governing body,\nthe officers and directors in the case of a corporation, and the\npartners or members in the case of a partnership or corporation, and the\nagent for service of process;\n (d) a statement of the financial condition of the organization,\nincluding, if appropriate, an income statement, balance sheet and\nprojected sources and uses of funds;\n (e) a statement generally describing the proposed operation of the\nhealth maintenance organization as to the location of its facilities,\nthe type and quantity of health care personnel engaged to provide\nservices, its quality assurance mechanism, its grievance procedure,\nparticipating hospitals and such other data as may be required by the\ncommissioner;\n (f) a copy of each enrollee contract filed with and approved by the\nsuperintendent pursuant to section forty-four hundred six of this\narticle; and\n (g) such other information as may be required by the commissioner to\nmake the determinations required in section forty-four hundred three of\nthis article.\n