NAC695C.115. Application of provider-sponsored organization.

For a provider-sponsored organization, an application for a certificate of authority must be verified by an officer or authorized representative of the applicant, must be in a form prescribed by the Commissioner and must set forth or be accompanied by the following:

     1. A copy of the basic organizational document, if any, of the applicant, and all amendments thereto;

     2. A copy of the bylaws, rules or regulations, or similar documents, if any, regulating the conduct of the internal affairs of the applicant;

     3. 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 officers in the case of a corporation, and the partners or members in the case of a partnership or association;

     4. A copy of any contract made or to be made between any providers or persons listed in subsection 3 and the applicant;

     5. A statement generally describing the provider-sponsored organization, the location of facilities at which health care services will be regularly available to enrollees and the type of health care personnel who will provide the health care services;

     6. Certified financial statements showing the assets, liabilities and sources of financial support of the applicant;

     7. A financial plan that includes a 3-year projection of the initial operating results anticipated and the sources of working capital as well as any other sources of funding;

     8. A description of the proposed method of marketing;

     9. A power of attorney duly executed by the applicant appointing the Commissioner and his or her 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 provider-sponsored organization on a cause of action arising in this State may be served;

     10. A statement reasonably describing the geographic area to be served; and

     11. A description of the procedures for the resolution of enrollee complaints.

     (Added to NAC by Comm’r of Insurance by R148-99, eff. 1-27-2000)