44-32,117. Certificate of authority; application; contents.

Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the director, and shall set forth or be accompanied by the following:

(1) A copy of the organizational documents of the applicant, such as the articles of incorporation, articles of association, articles of organization, partnership agreement, trust agreement, or other applicable documents and all amendments thereto;

(2) A copy of the bylaws, rules, and regulations or similar document, if any, regulating the conduct of the internal affairs of the applicant;

(3) A list of the names, addresses, and official positions and biographical information, on forms acceptable to the director, of the persons who are to be responsible for the conduct of the affairs and day-to-day operations of the applicant, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee and the principal officers in the case of a corporation or the partners or members in the case of a partnership, limited liability company, or association;

(4) A copy of any contract made or to be made between any class of providers and the health maintenance organization and a copy of any contract made or to be made between third-party administrators, marketing consultants, or persons listed in subdivision (3) of this section and the health maintenance organization;

(5) A copy of the form of evidence of coverage to be issued to subscribers;

(6) A copy of the form of group contract, if any, which is to be issued to employers, unions, trustees, or other organizations;

(7) Financial statements showing the applicant's assets, liabilities, and sources of financial support, including a copy of the applicant's most recent, regular, certified financial statement and an unaudited, current financial statement;

(8) A financial feasibility plan which includes detailed enrollment projections, the methodology for determining premium rates to be charged during the first twelve months of operations certified by an actuary or other qualified person, a projection of balance sheets, cash-flow statements showing any capital expenditures, any purchase and sale of investments, and any deposits with the state, income and expense statements anticipated from the start of operations until the health maintenance organization has had net income for at least one year, and a statement as to the sources of working capital as well as any other sources of funding;

(9) A power of attorney duly executed by such applicant, if not domiciled in this state, appointing the director and his or her successors and duly authorized deputies as the true and lawful attorney of such applicant in and for this state upon whom all lawful process in any legal action or proceeding against the health maintenance organization on a cause of action arising in this state may be served;

(10) A statement or map reasonably describing the geographic area to be served;

(11) A description of the internal grievance procedures to be utilized for the investigation and resolution of enrollee complaints and grievances;

(12) A description of the proposed quality assurance program, including the formal organizational structure, methods for developing criteria, procedures for comprehensive evaluation of the quality of care rendered to enrollees, and processes to initiate corrective action and reevaluation when deficiencies in provider or organizational performance are identified;

(13) A description of the procedures to be implemented to meet the protection-against-insolvency requirements in section 44-32,143;

(14) A list of the names, addresses, and license numbers, if any, of all providers with which the health maintenance organization has agreements; and

(15) Such other information as the director requires to make the determinations required in section 44-32,120.

Source:Laws 1990, LB 1136, § 26; Laws 1993, LB 121, § 250.