A. 1. Upon receipt of an application for issuance of a certificate of authority, the Insurance Commissioner shall forthwith transmit copies of such application and accompanying documents to the State Commissioner of Health.
2. The State Commissioner of Health shall determine whether the applicant for a certificate of authority, with respect to health care services to be furnished, has complied with the provisions of Section 7 of this act.
3. Within forty-five (45) days of receipt of an application for issuance of a certificate of authority from the Insurance Commissioner, the State Commissioner of Health shall certify to the Insurance Commissioner that the proposed health maintenance organization meets the requirements of Section 7 of this act, or shall notify the Insurance Commissioner that the proposed health maintenance organization does not meet such requirements and shall specify in what respects the applicant is deficient.
B. The Insurance Commissioner shall, within forty-five (45) days of receipt of a certification of compliance or notice of deficiency from the State Commissioner of Health, issue a certificate of authority to a person filing a completed application upon receipt of the prescribed fees and upon the Insurance Commissioner’s being satisfied that:
1. The persons responsible for the conduct of the affairs of the applicant are competent and trustworthy, and possess good reputations;
2. Any deficiency identified by the State Commissioner of Health has been corrected and the State Commissioner of Health has certified to the Insurance Commissioner that the health maintenance organization’s proposed plan of operation meets the requirements of Section 7 of this act;
3. The health maintenance organization will effectively provide or arrange for the provision of basic health care services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments or deductibles, or both; and
4. The health maintenance organization is in compliance with the provisions of Sections 13 and 15 of this act.
C. A certificate of authority shall be denied only after the Insurance Commissioner complies with the requirements of Section 20 of this act. No other criteria may be used to deny a certificate of authority.
Added by Laws 2003, c. 197, § 4, eff. Nov. 1, 2003.
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