Iowa Code 514B.3 – Application for a certificate of authority
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Terms Used In Iowa Code 514B.3
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
- state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
514B.3 Application for a certificate of authority.
1. An application for a certificate of authority shall be verified by an officer or authorized
representative of the health maintenance organization, shall be in a form prescribed by the commissioner, and shall set forth or be accompanied by the following:
a. A copy of the basic organizational document, if any, of the applicant such as the articles
of incorporation, articles of association, partnership agreement, trust agreement, or other applicable documents, and all of its amendments.
b. A copy of the bylaws, rules or similar document, if any, regulating the conduct of the
internal affairs of the applicant.
c. A list of the names, addresses and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers if a corporation and the partners or members if a partnership or association.
d. A copy of any contract made or to be made between any providers or persons listed in paragraph “”c”” and the applicant.
e. A statement generally describing the health maintenance organization including, but not limited to, a description of its facilities and personnel.
f. A copy of the form of evidence of coverage.
g. A copy of the form of the group contract, if any, which is to be issued to employers, unions, trustees or other organizations.
h. Financial statements showing the applicant’s assets, liabilities and sources of financial support. If the applicant’s financial affairs are audited by an independent certified public accountant, a copy of the applicant’s most recent regular certified financial statement shall satisfy this requirement unless the commissioner directs that additional financial information is required for the proper administration of this chapter.
i. A description of the proposed method of marketing the plan, a financial plan which includes a three-year projection of operating results anticipated, and a statement as to the sources of funding.
j. A power of attorney executed by any applicant appointing the commissioner, the commissioner’s successors in office, and deputies to receive process in any legal action or proceeding against the health maintenance organization on a cause of action arising in this state.
k. A statement reasonably describing the geographic area to be served.
l. A description of the complaint procedures to be utilized as required under section
514B.14.
m. A description of the procedures and programs to be implemented to meet the requirements for quality of health care as determined by the director of health and human services under § 514B.4.
n. A description of the mechanism by which enrollees shall be allowed to participate in matters of policy and operation as required by § 514B.7.
o. Other information the commissioner finds reasonably necessary to make the determinations required in § 514B.5.
2. A health maintenance organization shall, unless otherwise provided for in this chapter, file notice with the commissioner and receive approval from the commissioner before modifying the operations described in the information required by this section.
3. Upon receipt of an application for a certificate of authority, the commissioner shall immediately transmit copies of the application and accompanying documents to the director of health and human services and the affected regional health planning council, as authorized by Pub. L. No. 89-749, 42 U.S.C. § 246(b)2b, for their nonbinding consultation and advice.
[C75, 77, 79, 81, §514B.3]
2003 Acts, ch 91, §28; 2006 Acts, ch 1010, §140; 2012 Acts, ch 1023, §116; 2023 Acts, ch 19,
§1193, 1194
Referred to in §514B.5, 514B.12
Subsection 1, paragraph m amended
Subsection 3 amended
1. An application for a certificate of authority shall be verified by an officer or authorized
representative of the health maintenance organization, shall be in a form prescribed by the commissioner, and shall set forth or be accompanied by the following:
a. A copy of the basic organizational document, if any, of the applicant such as the articles
of incorporation, articles of association, partnership agreement, trust agreement, or other applicable documents, and all of its amendments.
b. A copy of the bylaws, rules or similar document, if any, regulating the conduct of the
internal affairs of the applicant.
c. A list of the names, addresses and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers if a corporation and the partners or members if a partnership or association.
d. A copy of any contract made or to be made between any providers or persons listed in paragraph “”c”” and the applicant.
e. A statement generally describing the health maintenance organization including, but not limited to, a description of its facilities and personnel.
f. A copy of the form of evidence of coverage.
g. A copy of the form of the group contract, if any, which is to be issued to employers, unions, trustees or other organizations.
h. Financial statements showing the applicant’s assets, liabilities and sources of financial support. If the applicant’s financial affairs are audited by an independent certified public accountant, a copy of the applicant’s most recent regular certified financial statement shall satisfy this requirement unless the commissioner directs that additional financial information is required for the proper administration of this chapter.
i. A description of the proposed method of marketing the plan, a financial plan which includes a three-year projection of operating results anticipated, and a statement as to the sources of funding.
j. A power of attorney executed by any applicant appointing the commissioner, the commissioner’s successors in office, and deputies to receive process in any legal action or proceeding against the health maintenance organization on a cause of action arising in this state.
k. A statement reasonably describing the geographic area to be served.
l. A description of the complaint procedures to be utilized as required under section
514B.14.
m. A description of the procedures and programs to be implemented to meet the requirements for quality of health care as determined by the director of health and human services under § 514B.4.
n. A description of the mechanism by which enrollees shall be allowed to participate in matters of policy and operation as required by § 514B.7.
o. Other information the commissioner finds reasonably necessary to make the determinations required in § 514B.5.
2. A health maintenance organization shall, unless otherwise provided for in this chapter, file notice with the commissioner and receive approval from the commissioner before modifying the operations described in the information required by this section.
3. Upon receipt of an application for a certificate of authority, the commissioner shall immediately transmit copies of the application and accompanying documents to the director of health and human services and the affected regional health planning council, as authorized by Pub. L. No. 89-749, 42 U.S.C. § 246(b)2b, for their nonbinding consultation and advice.
[C75, 77, 79, 81, §514B.3]
2003 Acts, ch 91, §28; 2006 Acts, ch 1010, §140; 2012 Acts, ch 1023, §116; 2023 Acts, ch 19,
§1193, 1194
Referred to in §514B.5, 514B.12
Subsection 1, paragraph m amended
Subsection 3 amended