§ 26-34-104 — Issuance of certificate of authority

Wyoming § 26-34-104

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 34: HEALTH MAINTENANCE ORGANIZATIONS

Text

(a) Upon receipt of an application for issuance of a
certificate of authority, the commissioner shall immediately
transmit a copy of the application and accompanying documents to
the administrator.
(b) The administrator shall determine whether the
applicant for a certificate of authority, with respect to health
care services to be furnished has complied with W.S. 26-34-108.
(i) Repealed by Laws 1995, ch. 210, § 5.
(ii) Repealed by Laws 1995, ch. 210, § 5.
(iii) Repealed by Laws 1995, ch. 210, § 5.
(c) Within forty-five (45) days of receipt of the
application for issuance of a certificate of authority, the
administrator shall certify to the commissioner that the
proposed health maintenance organization meets the requirements
of W.S. 26-34-108 or notify the commissioner that the health
maintenance organization does not meet the requirements and
specify in what respects it is deficient.
(d) The commissioner shall issue or deny a certificate of
authority to any person filing an application pursuant to W.S.
26-34-103 within fifteen (15) days of receipt of the
certification from the administrator. Issuance of a certificate
of authority shall be granted upon payment of the application
fee prescribed in W.S. 26-34-126 if the commissioner is
satisfied that the following conditions are met:
(i) The persons responsible for the conduct of the
applicant's affairs are competent and trustworthy;
(ii) The administrator certifies that the health
maintenance organization's proposed plan of operation meets the
requirements of W.S. 26-34-108;
(iii) The health maintenance organization shall
effectively provide or arrange for the provision of basic health
care services on a prepaid basis, through insurance or
otherwise, except to the extent of reasonable requirements for
copayments, coinsurance and deductibles;
(iv) The health maintenance organization is
financially responsible and may reasonably be expected to meet
its obligations to enrollees and prospective enrollees. In
making this determination, the commissioner may consider:
(A) The financial soundness of the arrangements
for health care services and the schedule of premiums used in
connection therewith;
(B) The adequacy of working capital;
(C) Any agreement with an insurer, a hospital or
medical service corporation, a government or any other
organization or entity for insuring the payment of the cost of
health care services or the provision for automatic
applicability of an alternative coverage in the event of
discontinuance of the health maintenance organization;
(D) Any agreement with providers for the
provision of health care services; and
(E) Any deposit of cash or securities submitted
in accordance with W.S. 26-34-114.
(v) Repealed by Laws 1995, ch. 210, § 5.
(vi) Nothing in the proposed method of operation, as
shown by the information submitted pursuant to W.S. 26-34-103 or
by independent investigation, is contrary to the public
interest; and
(vii) Any deficiencies identified by the
administrator have been corrected.
(e) A certificate of authority shall be denied only after
compliance with the requirements of W.S. 26-34-125.