2018 Arkansas Code
Title 23 - Public Utilities and Regulated Industries
Subtitle 3 - Insurance
Chapter 76 - Health Maintenance Organizations
§ 23-76-108. Issuance of certificate of authority
(a) Upon receipt of an application for issuance of a certificate of authority, the Insurance Commissioner shall determine whether the applicant furnishes or proposes to furnish adequate and accessible healthcare services for its healthcare plans subject to the requirements or rules of the State Insurance Department.
(b) The commissioner shall issue a certificate of authority to any person filing an application pursuant to § 23-76-107 within sixty (60) days of receipt of the application if the commissioner is satisfied that:
(1) The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and possess good reputations;
(2) The health maintenance organization's proposed plan of operation meets the requirements of subsection (a) of this section;
(3) The healthcare plan will allow the health maintenance organization effectively to provide or arrange for the provision of basic healthcare services through insurance or otherwise on a prepaid basis, subject to reasonable requirements for copayments;
(4) The health maintenance organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees;
(5) The healthcare plan's arrangements for healthcare services and the schedule of charges for use therewith are financially sound and reasonable;
(6) Any agreements with insurers, hospitals, medical service corporations, governmental entities, or any other organizations for insuring the payment of the cost of healthcare services or the provision for automatic applicability of alternative coverage in the event of discontinuance of the healthcare plan are reasonable and adequate;
(7) Agreements with providers for the provision of healthcare services are reasonable and adequate;
(8) The enrollees will be afforded an opportunity to participate in matters of policy and operation pursuant to § 23-76-110;
(9) Nothing in the proposed method of operation, as shown by the information submitted pursuant to § 23-76-107 or by independent investigation, is contrary to the public interest;
(10) Any deposit of cash or securities, in an amount determined to be appropriate by the commissioner pursuant to § 23-76-118, is sufficient to guarantee that the obligations to provide the promised benefits will be performed; and
(11) The applicant has paid-in capital in an amount not less than one hundred thousand dollars ($100,000) and additional working capital or surplus funds in an amount deemed by the commissioner to be adequate in relation to the proposed plan of operation.
(c) A certificate of authority shall be denied by the commissioner only after compliance with the requirements of § 23-76-126.
