2023 South Dakota Codified Laws
Title 58 - Insurance
Chapter 41 - Health Maintenance Organizations
Section 58-41-17 - Issuance or denial of certificate--Fee--Conditions for issuance.
58-41-17. Issuance or denial of certificate--Fee--Conditions for issuance.
The director of the Division of Insurance shall issue or deny a certificate of authority to any person filing an application pursuant to this chapter. Issuance of a certificate of authority shall be granted upon payment of the application fee prescribed in §58-41-26 if the director is satisfied that the following conditions are met:
(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 §58-41-12;
(3)The health maintenance contract constitutes an appropriate mechanism whereby the health maintenance organization will effectively provide or arrange for the provision of comprehensive health maintenance services on a prepaid basis, through insurance or otherwise, except to the extent of 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 health maintenance organization will assume full financial risk on a prospective basis for the provision of comprehensive health maintenance services, including hospital care;
(6)The enrollees will be afforded an opportunity to participate in matters of policy and operation pursuant to §§58-41-23 and 58-41-24; and
(7)Nothing in the proposed method of operation, as shown by the information submitted pursuant to §§58-41-4 to 58-41-10, inclusive, or by independent investigation, is contrary to the public interest.
A certificate of authority may be denied only after compliance with the requirements of §§58-41-87 to 58-41-90, inclusive.
Source: SL 1974, ch 321, §10; SL 1985, ch 393, §15; SL 2013, ch 256, §8.
