44-4705. Issuance of certificate of authority; conditions; denial.

279 words·~1 min read·/ne/chapter-44/44-4705

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(1)Following receipt of an application filed pursuant to section 44-4704 , the director shall review such application and notify the applicant of deficiencies therein. The director shall issue a certificate of authority if the following conditions are met:

(a)The requirements of section 44-4704 have been fulfilled;

(b)The individuals responsible for the conduct of the affairs of the applicant are competent and trustworthy, possess good reputations, and have had appropriate experience, training, or education;

(c)The applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and to prospective enrollees. In making this determination, the director may consider:

(i)The financial soundness of the applicant's arrangements for limited health services and the minimum standard rates, deductibles, copayments, and other patient charges used in connection therewith;

(ii)The adequacy of working capital, other sources of funding, and provisions for contingencies;

(iii)Any agreement providing for payment of the cost of the limited health services or for alternative coverage in the event of insolvency of the prepaid limited health service organization; and

(iv)The manner in which the requirements of section 44-4718 have been fulfilled;

(d)The agreements with providers for the provision of limited health services contain the provisions required by section 44-4717 ; and

(e)Any deficiencies identified by the director have been corrected.

(2)If the certificate of authority is denied, the director shall notify the applicant by certified mail and shall specify the reasons for denial in the notice. The prepaid limited health service organization shall have ten days from the date of receipt of the notice to request a hearing before the director pursuant to the Administrative Procedure Act.