58-41-17. Issuance or denial of certificate--Fee--Conditions for issuance.
258 words·~1 min read·
/sd/title-58/chapter-58-41/58-41-17A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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.