§ 26-34-134 — 26-34-103. Establishment of health maintenance organizations

Wyoming § 26-34-134

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

Text

(a) Notwithstanding any law of this state to the contrary,
any person may apply to the commissioner for a certificate of
authority to establish and operate a health maintenance
organization in compliance with this chapter. No person shall
establish or operate a health maintenance organization in this
state, without obtaining a certificate of authority under this
chapter.
(b) Any health maintenance organization in operation as of
July 1, 1995, shall submit an application for a certificate of
authority under this section not later than August 1, 1995. Each
applicant may continue to operate until the commissioner acts
upon the application. If an application is denied under W.S.
26-34-104, the applicant shall be treated as a health
maintenance organization whose certificate of authority has been
revoked.
(c) Each application for a certificate of authority shall
be verified by an officer or authorized representative of the
applicant, shall be in a form the commissioner prescribes and
shall set forth or be accompanied by the following:
(i) A copy of the applicant's organizational
documents, such as the articles of incorporation, articles of
association, partnership agreement, trust agreement or other
applicable documents, and all amendments thereto;
(ii) A copy of the bylaws, rules and regulations or
similar document, if any, regulating the conduct of the
applicant's internal affairs;
(iii) A list of the names, addresses, biographical
information and official positions of the persons who are to be
responsible for the conduct of the applicant's affairs,
including all members of the board of directors, board of
trustees, executive committee or other governing board or
committee, the principal officers in the case of a corporation,
and the partners or members in the case of a partnership or
association;
(iv) A copy of any contract made or to be made
between any providers, third party administrators, marketing
consultants or persons listed in paragraph (iii) of this
subsection and the health maintenance organization;
(v) A copy of the form of evidence of coverage to be
issued to the enrollees;
(vi) A copy of the form or group contract, if any,
which is to be issued to employers, unions, trustees or other
organizations;
(vii) Financial statements prepared in conformity
with the requirements of this code showing the applicant's
assets, liabilities and sources of financial support. A copy of
the applicant's most recent certified financial statement and an
unaudited current financial statement shall be included;
(viii) A financial feasibility plan which includes
detailed enrollment projections, the methodology for determining
premium rates to be charged during the first twelve (12) months
of operations certified by an actuary or other qualified person,
a projection of balance sheets, cash flow statements showing any
capital expenditures, purchase and sale of investments and
deposits with the state and income and expense statements
anticipated from the start of operations until the organization
has had net income for at least one (1) year and a statement as
to the sources of working capital as well as any other sources
of funding;
(ix) A power of attorney executed by the applicant,
if not domiciled in this state, appointing the commissioner and
his successors in office, and authorized deputies, as the true
and lawful attorney of the applicant in and for this state upon
whom all lawful process in any legal action or proceeding
against the health maintenance organization on a cause of action
arising in this state may be served;
(x) A statement reasonably describing the geographic
area or areas to be served;
(xi) A description of the complaint procedures to be
used as required under W.S. 26-34-112;
(xii) A description of the procedures and programs to
be implemented to meet the quality of health care requirements
in W.S. 26-34-104(b);
(xiii) Repealed by Laws 1995, ch. 210, § 5.
(xiv) A description of the procedures to be
implemented to meet the protection against insolvency
requirements in W.S. 26-34-114;
(xv) A list of the names, addresses and professional
license numbers of all providers with which the health
maintenance organization has agreements;
(xvi) A description of the quality assurance program
and the mechanisms in place to assure availability,
accessibility and continuity of care required under W.S.
26-34-108;
(xvii) Any other information the commissioner
requires to make the determinations specified in W.S. 26-34-104.
(d) Any applicant or health maintenance organization
holding a certificate of authority granted under this chapter,
unless otherwise provided for in this chapter, shall file a
notice describing any material modification of the operation set
out in the information required by subsection (c) of this
section. The notice shall be filed with the commissioner prior
to the modification. If the commissioner does not disapprove
within forty-five (45) days of filing, the modification is
deemed approved.
(e) The commissioner may promulgate rules and regulations
exempting from the filing requirements of subsection (a) of this
section those items he deems unnecessary.
(f) Any applicant or health maintenance organization
holding a certificate of authority granted under this chapter
shall file all contracts of reinsurance with the commissioner.
Any agreement between the organization and an insurer is subject
to the requirements of this code regarding reinsurance. All
reinsurance agreements and any modifications thereto shall be
filed and approved before the effective date of any agreement or
modification. Reinsurance agreements shall remain in full force
and effect for at least ninety (90) days following written
notice to the commissioner, by registered mail, of cancellation
by either party.