2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514B - HEALTH MAINTENANCE ORGANIZATIONS
514B.5 - ISSUANCE AND DENIAL OF A CERTIFICATE OF AUTHORITY.

        514B.5  ISSUANCE AND DENIAL OF A CERTIFICATE OF
      AUTHORITY.
         The commissioner shall issue or deny a certificate of authority to
      any person filing an application pursuant to section 514B.3 within a
      reasonable period of time.  Issuance of a certificate of authority
      shall be granted upon payment of the application fee prescribed in
      section 514B.22 if the commissioner is satisfied that the following
      conditions are met:
         1.  The persons responsible for the conduct of the affairs of the
      applicant are competent and trustworthy.
         2.  The commissioner finds that the health maintenance
      organization's proposed plan of operation meets the requirements of
      section 514B.4.
         3.  The health maintenance organization provides or arranges for
      the provision of basic health care services on a prepaid basis,
      except that the health maintenance organization may impose deductible
      and coinsurance charges subject to approval by the commissioner.  The
      commissioner has the authority to promulgate rules pursuant to
      chapter 17A establishing reasonable maximum deductible and
      coinsurance charges which may be imposed by health maintenance
      organizations.
         4.  The health maintenance organization is fiscally sound and may
      reasonably be expected to meet its obligations to enrollees.  In
      making this determination, the commissioner may consider:
         a.  The financial soundness of the health maintenance
      organization's arrangements for health care services in relation to
      its schedule of charges.
         b.  The adequacy of the health maintenance organization's
      working capital.
         c.  Any agreement made by the health maintenance organization
      with an insurer, a corporation authorized under chapter 514 or any
      other organization for insuring the payment of the cost of health
      care services or for providing immediate alternative coverage in the
      event of discontinuance of the health maintenance organization.
         d.  Any agreement made with providers for the provision of
      health care services.
         e.  Any surety bond or deposit of cash or securities submitted
      in accordance with section 514B.16.
         5.  The enrollees may participate in matters of policy and
      operation pursuant to section 514B.7.
         6.  Nothing in the proposed method of operation as shown by the
      information submitted pursuant to section 514B.3 or by independent
      investigation is contrary to the public interest.
         A certificate of authority shall be denied only after compliance
      with the requirements of section 514B.26.  

         Section History: Early Form

         [C75, 77, 79, 81, § 514B.5] 

         Section History: Recent Form

         92 Acts, ch 1162, § 22, 23
         Referred to in § 513C.4, 514B.3, 514B.9