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304.17A-808 Application for certificate of filing - Fee.
A proposed self-insured employer-organized association group shall file with the <br>commissioner an application for a certificate of filing accompanied by a nonrefundable <br>filing fee of five dollars ($5). Each application for a certificate of filing shall be submitted <br>to the commissioner upon a form prescribed by the commissioner and shall set forth or be <br>accompanied by: <br>(1) The group's name, location of its principal office, date of organization, and
identification of its fiscal year. The application shall also include the name and <br>address of each member if known at the time of application. If this information is <br>unknown, a description of the group to be solicited for membership shall be <br>included;
(2) A copy of the articles of association or governance documents; <br>(3) A copy of agreements with the administrator and with any service company; <br>(4) A copy of the bylaws of the proposed group; <br>(5) Certification of the group's financial solvency as set forth in KRS 304.17A-812; <br>(6) Designation of the initial board of trustees and administrator; <br>(7) The address where books and records of the group will be maintained at all times;
and
(8) A statement describing the self-insured employer-organized association which shall
include: <br>(a) The health services to be offered; <br>(b) The financial risks to be assumed; <br>(c) The initial geographic area to be served; <br>(d) Pro forma financial projections for the first three (3) years of operation,
including the assumptions the projections are based upon;
(e) The sources of working capital and funding; <br>(f) A description of the persons to be covered by the self-insured employer-
organized association;
(g) Any proposed reinsurance arrangements; <br>(h) Any proposed management, administrative, or cost-sharing arrangements; and <br>(i) A description of the self-insured employer-organized association's proposed
method of marketing.
Effective: July 15, 2010 <br>History: Amended 2010 Ky. Acts ch. 24, sec. 1259, effective July 15, 2010. -- Created
2003 Ky. Acts ch. 78, sec. 5, effective June 24, 2003.
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