41-3408. QUALIFICATIONS FOR CERTIFICATE OF AUTHORITY. The director shall not issue or permit to exist a certificate of authority to be or act as a service corporation, as to any corporation not fulfilling the following qualifications:
(1) Must be incorporated as provided in section 41-3406, Idaho Code, as a professional service corporation.
(2) Must intend to and actually conduct its business in good faith as a nonprofit corporation.
(3) Must have in force service agreements with participant licensees located in the areas of the subscribers’ residences convenient as to location and sufficient in numbers, capacity and facilities reasonably to furnish respective categories of health care services then provided or proposed to be provided by the corporation to its subscribers. Said professional service corporation shall be ready and willing at all times to enter into service agreements with all licensees of the category or categories specified in its articles of incorporation who are qualified under the laws of the state of Idaho and who desire to become participant licensees of said corporation and who practice within the general area served by said professional service corporation.
(4) If a newly formed corporation, it must possess sufficient available working funds to pay all reasonably anticipated cost of acquisition of new business and operating expenses, other than payment for professional services, for a period of not less than the six (6) months next following the date of issuance of the certificate of authority, if issued.
(5) Nothing in this section shall preclude a service corporation from refusing to contract with a health care licensee who is unqualified or who does not meet the terms and conditions of the participating licensee contract of the service corporation or from terminating or refusing to renew the contract of a participating health care licensee who is unqualified or who does not comply with, or who refuses to comply with, the terms and conditions of the participating health care licensee contract including, but not limited to, practice standards and quality requirements. The contract shall provide for written notice to the participating health care licensee setting forth any breach of contract for which the service corporation proposes that the contract be terminated or not renewed and shall provide for a reasonable period of time for the participating health care licensee to cure such breach prior to termination or nonrenewal. If the breach has not been cured within such period of time the contract may be terminated or not renewed. Provided however, that if the breach of contract for which the service corporation proposes that the contract be terminated or not renewed is a willful breach, fraud or a breach which poses an immediate danger to the public health or safety, the contract may be terminated or not renewed immediately.
(6) Every service corporation issuing benefits pursuant to this chapter shall establish a grievance system for licensees. Such grievance system shall provide for arbitration according to chapter 9, title 7, Idaho Code, or for such other system which provides reasonable due process provisions for the resolution of grievances and the protection of the rights of the parties.
(7) Must fulfill all other applicable requirements of this chapter.
History:
[41-3408, added 1961, ch. 330, sec. 766, p. 645; am. 1965, ch. 46, sec. 2, p. 70; am. 1967, ch. 91, sec. 2, p. 194; am. 1967, ch. 399, sec. 4, p. 1194; am. 1969, ch. 36, sec. 4, p. 86; am. 1971, ch. 252, sec. 4, p. 1008; am. 1994, ch. 78, sec. 4, p. 179; am. 1994, ch. 275, sec. 2, p. 854; am. 2007, ch. 90, sec. 22, p. 259.]
Structure Idaho Code
Chapter 34 - HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS
Section 41-3401 - SCOPE OF CHAPTER.
Section 41-3402 - PURPOSE AND INTERPRETATION.
Section 41-3403 - DEFINITIONS.
Section 41-3404 - PROVISIONS EXCLUSIVE.
Section 41-3405 - INCORPORATION — CERTIFICATE OF AUTHORITY REQUIRED.
Section 41-3407 - NAME OF CORPORATION.
Section 41-3408 - QUALIFICATIONS FOR CERTIFICATE OF AUTHORITY.
Section 41-3409 - APPLICATION FOR CERTIFICATE OF AUTHORITY.
Section 41-3410 - ISSUANCE OR REFUSAL OF CERTIFICATE OF AUTHORITY.
Section 41-3411 - CONTINUANCE OR EXPIRATION OF CERTIFICATE OF AUTHORITY.
Section 41-3412 - SUSPENSION OR REVOCATION OF CERTIFICATE OF AUTHORITY.
Section 41-3413 - SERVICES AND BENEFITS WHICH MAY BE PROVIDED PROFESSIONAL SERVICE CORPORATIONS.
Section 41-3414 - SERVICES AND BENEFITS WHICH MAY BE PROVIDED — HOSPITAL SERVICE CORPORATIONS.
Section 41-3415 - PROFESSIONAL SERVICE AGREEMENTS.
Section 41-3415A - PHARMACISTS’ SERVICE AGREEMENTS.
Section 41-3416 - HOSPITAL SERVICE AGREEMENTS.
Section 41-3417 - SUBSCRIBER’S CONTRACTS.
Section 41-3419 - FILING AND APPROVAL OF AGREEMENTS AND CONTRACTS.
Section 41-3420 - CHARGES AND RATES.
Section 41-3422 - SURPLUS FUND.
Section 41-3423 - INVESTMENTS.
Section 41-3424 - RECORDS AND ACCOUNTS.
Section 41-3425 - ANNUAL STATEMENT.
Section 41-3426 - EXAMINATION.
Section 41-3427 - TAXATION AND ANNUAL REPORT.
Section 41-3428 - JOINT OPERATIONS.
Section 41-3429 - COMBINED CORPORATION.
Section 41-3430 - CONTRACTS COVERING WORKMEN’S COMPENSATION RISKS.
Section 41-3431 - ANNUAL ADJUSTMENT OF SERVICE PAYMENTS — DISPOSITION OF EXCESS FUNDS.
Section 41-3432 - FIDELITY BOND.
Section 41-3433 - SERVICE CORPORATION FEES.
Section 41-3434 - OTHER PROVISIONS APPLICABLE.
Section 41-3435 - PRODUCER LICENSING.
Section 41-3437 - REQUIRED PROVISIONS — INFANTS.
Section 41-3438 - COMPLICATIONS OF PREGNANCY.
Section 41-3439 - LIMITATION OF BENEFITS FOR ELECTIVE ABORTIONS.
Section 41-3440 - SERVICES PROVIDED BY GOVERNMENTAL ENTITIES.
Section 41-3441 - MAMMOGRAPHY COVERAGE.
Section 41-3443 - BEST PRICE — MOST FAVORED NATIONS CLAUSE PROHIBITED.
Section 41-3444 - CONTRACTS WITH PROVIDERS OF DENTAL SERVICES.