Sec. 9. (a) After receiving an application filed under section 8 of this chapter, the commissioner shall review the application and notify the applicant of any deficiencies in the application.
(b) The commissioner shall issue a certificate of authority to an applicant if the following conditions are met:
(1) The requirements of section 8 of this chapter have been fulfilled.
(2) The individuals responsible for conducting the affairs of the applicant are competent, trustworthy, possess good reputations, and have had appropriate experience, training, or education.
(3) 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 commissioner may consider:
(A) the financial soundness of the arrangements of the applicant for limited health services;
(B) the adequacy of the applicant's working capital, other sources of funding, and provisions for contingencies;
(C) any agreement for paying the cost of the limited health services or for alternative coverage in the event of insolvency of the limited service health maintenance organization; and
(D) the manner in which the requirements of sections 16 and 17 of this chapter have been fulfilled.
(4) The agreements with providers for the provision of limited health services contain the provisions required by section 15 of this chapter.
(5) Any deficiencies identified by the commissioner have been corrected.
(c) If an application for a certificate of authority is denied, the commissioner shall notify the applicant and shall specify in the notice the reasons for the denial of the application. Within thirty (30) days after receiving the notice, the applicant may request a hearing before the commissioner under IC 4-21.5.
As added by P.L.26-1994, SEC.25.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 34. Limited Service Health Maintenance Organizations
27-13-34-0.1. Application of Certain Amendments to Chapter
27-13-34-1. "Enrollee" Defined
27-13-34-2. "Evidence of Coverage" Defined
27-13-34-3. "Limited Health Services" Defined
27-13-34-4. "Limited Service Health Maintenance Organization" Defined
27-13-34-5. "Provider" Defined
27-13-34-6. "Subscriber" Defined
27-13-34-7. Certificate of Authority Required; Foreign Entities
27-13-34-8. Application for Certificate of Authority; Requirements
27-13-34-9. Issuance of Certificate of Authority; Application Deficiencies; Denial of Application
27-13-34-10. Powers of Limited Service Health Maintenance Organization
27-13-34-11. Modification of Documents; Filing; Disapproval
27-13-34-12. Applicable Statutes
27-13-34-13. Evidence of Coverage; Required Information
27-13-34-14. Examinations by Commissioner
27-13-34-15. Required Contract Terms and Conditions; Exemptions
27-13-34-18. Fidelity Bonds; Deposit in Place of Bond
27-13-34-19. Annual Reports; Additional Reports
27-13-34-20. Suspension or Revocation of Certificate of Authority
27-13-34-21. Chapter Violations; Fines and Penalties
27-13-34-22. Supervision, Rehabilitation, or Liquidation; Remedies and Measures
27-13-34-24. Dental Care Services and Director; Review of Adverse Decisions; Complaints