Effective 28 Aug 1987
354.704. Application for certificate of authority, content. — An application for a certificate of authority to operate a prepaid dental plan corporation in this state shall be filed with the director on a form prescribed by the director. Such application shall be verified by an officer or authorized representative of the applicant and shall set forth, or be accompanied by, the following:
(1) A duly certified copy of the corporation's articles of incorporation or articles of association with all amendments;
(2) A copy of the corporation's bylaws or regulations governing the conduct of the internal affairs of the corporation;
(3) A list of the names, addresses, and official positions of the persons who are responsible for the conduct of the affairs of the corporation, including all members of the board of directors;
(4) A copy of any contract made or to be made between any providers and the applicant;
(5) A statement generally describing the prepaid dental plan to be offered and the corporation's facilities and personnel;
(6) A copy of contracts and contract certificates to be issued to the enrollees;
(7) A copy of any group enrollee contract which is to be issued;
(8) Financial statements showing the applicant's assets, liabilities, and sources of financial support. If the applicant's financial affairs are audited by independent certified public accountants, a copy of the applicant's most recent regular certified financial statement shall satisfy this requirement unless the director determines that additional or more recent financial information is required;
(9) A description of the proposed method of marketing the prepaid dental plan, a financial plan which includes a three-year projection of the initial operating results anticipated, and a statement as to the sources of funding;
(10) A description of the procedures to provide emergency dental benefits;
(11) A statement reasonably describing the geographic area to be served;
(12) A fee of two hundred dollars for issuance of a certificate of authority; and
(13) Such other information as the director may require.
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(L. 1987 S.B. 272 § 3)
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