Application for certificate. An application for a certificate of authority to operate a prepaid limited health service organization must be filed with the Commissioner on a form prescribed by him. The application must be verified by an officer or authorized representative of the applicant and include:
1. A copy of the applicant’s basic organizational document, including any articles of incorporation, articles of association, partnership agreement, trust agreement or any other applicable document or amendment thereto.
2. A copy of the bylaws, rules and regulations or similar documents, if any, which regulate the conduct of the internal affairs of the applicant.
3. A list of the names, addresses, official positions and biographical information of the persons responsible for conducting the applicant’s affairs, including, but not limited to:
(a) The members of the board of directors;
(b) The members of the board of trustees;
(c) The members of the executive committee or other governing board or committee;
(d) The principal officers;
(e) Any person owning or having the right to acquire 10 percent or more of the voting securities of the applicant; and
(f) If the applicant is a partnership or association, the partners or members of that partnership or association.
4. A statement generally describing the applicant, its facilities, employees and the limited health service or services to be offered.
5. A copy of any contract made or to be made between the applicant and any provider concerning the provision of a limited health service to enrollees.
6. A copy of any contract made, or to be made between the applicant and any person described in subsection 3 of this section.
7. A copy of any contract made or to be made between the applicant and any person for the performance on the applicant’s behalf of any functions, including, but not limited to, marketing, administration, enrollment, management of investments and subcontracting for the provision of a limited health service to enrollees.
8. A copy of the form of any group contract which is to be issued to employers, unions, trustees or other organizations.
9. A copy of any form for evidence of coverage to be issued to subscribers.
10. A copy of the applicant’s most recent financial statements which have been audited by an independent certified public accountant. If the financial affairs of the parent company of the applicant are audited by an independent certified public accountant and the financial affairs of the applicant are not audited, the applicant must submit a copy of the most recently audited financial statement of the parent company which was certified by an independent certified public accountant and the consolidating financial statements of the applicant, unless the Commissioner determines that additional or more recent financial information is required.
11. A copy of the applicant’s financial plan, including a 3-year projection of the anticipated operating results, a statement of the sources of working capital and any other sources of funding and any plan for contingencies.
12. A schedule of the rates and charges for the limited health service.
13. A description of the proposed method of marketing.
14. A statement acknowledging that any process in any legal action or proceeding against the applicant on a cause of action arising in this state is valid if lawfully served.
15. A description of the procedure for the resolution of complaints submitted by enrollees concerning the limited health service provided by the prepaid limited health service organization.
16. A description of the procedures to be established for quality assessment and utilization review.
17. A description of the applicant’s plan to comply with the provisions of NRS 695F.200.
18. The fee for filing an application for a certificate of authority.
19. Such other information as the Commissioner may require to make the determination required by this chapter.
Last modified: February 27, 2006