US Laws, Codes, Statutes & Cases

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 39
                             MANAGED CARE REFORM
    41-3906.  APPLICATION FOR CERTIFICATE OF AUTHORITY. (1) The application
for a certificate of authority shall be in writing in the form prescribed by
the director. It shall be verified by an officer of an applicant corporation
or association, or member of an applicant firm, or by the applicant if an
individual. The application shall set forth or be accompanied by:
    (a)  a copy of the basic organizational document of the applicant, such as
    articles of incorporation or of association, partnership agreement, trust
    agreement, or other applicable documents, and all amendments thereto;
    (b)  a copy of the bylaws, rules, or similar document regulating conduct
    of the applicant's internal affairs;
    (c)  a listing of the names, addresses, principal occupations, and
    official positions of the individuals who are to be responsible for the
    conduct of 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;
    (d)  a copy of any contract made or to be made between the applicant and
    any provider, and the applicant and any person named in subsection (c)
    hereof;
    (e)  a statement generally describing the managed care organization, its
    health care plan or plans, facilities, and personnel;
    (f)  a copy of each form of health care contract proposed to be issued;
    (g)  financial statements showing the applicant's audited assets,
    liabilities, and sources and amount of financial support. A copy of the
    applicant's most recent regular certified financial statement shall be
    deemed to satisfy this requirement unless the director directs that
    additional or more recent financial information is required for proper
    administration of this chapter;
    (h)  a financial plan, which includes a three (3) year projection of
    initial operating results anticipated, and a statement as to the sources
    of working capital as well as any other source of funding;
    (i)  a description of the proposed method of marketing the plan;
    (j)  a statement of the geographic area or areas to be served;
    (k)  a description of the grievance procedures as required under section
    41-3918, Idaho Code;
    (l)  a description of the system and procedures for monitoring the quality
    of health care services as required by section 41-3905(6)(a), Idaho Code;
    (m)  a description of the mechanism by which members will be given an
    opportunity to participate in matters of policy and operation as required
    by section 41-3916, Idaho Code;
    (n)  if the applicant is not domiciled in this state, a power of attorney
    duly executed by the applicant and irrevocably appointing the director and
    his successors in office as the applicant's attorney upon whom may be
    served all lawful process in any legal action or proceeding against the
    managed care organization on a cause of action arising in this state; and
    (o)  such other information as the director may reasonably require as to
    the applicant's qualifications as a managed care organization.
    (2)  Every organization authorized to offer a managed care plan under a
certificate  of authority issued prior to July 1, 1997, shall comply with any
new or additional requirements, other than applicable capital, surplus and
deposit requirements, imposed by this act by January 1, 1998. If the
organization does not comply by January 1, 1998, the organization shall no
longer be authorized to offer managed care plans on a predetermined and
prepaid basis in this state.