(a) Before issuing orcontinuing any such license, the Commissioner of Insurance may make such anexamination or investigation as he deems expedient. The Commissioner ofInsurance shall issue a license upon the payment of the application feeprescribed in G.S. 58‑67‑160 and upon being satisfied on thefollowing points:
(1) The applicant isestablished as a bona fide health maintenance organization as defined by thisArticle;
(2) The rates chargedand benefits to be provided are fair and reasonable;
(3) The amounts providedas working capital are repayable only out of earned income in excess of amountspaid and payable for operating expenses and expenses of providing services andsuch reserve as the Department of Insurance deems adequate, as providedhereinafter;
(4) That the amount ofmoney actually available for working capital be sufficient to carry allacquisition costs and operating expenses for a reasonable period of time fromthe date of the issuance of the license and that the health maintenanceorganization is financially responsible and may reasonably be expected to meetits obligations to enrollees and prospective enrollees. Such working capitalshall initially be a minimum of one million five hundred thousand dollars($1,500,000) for any full service medical health maintenance organization.Initial working capital for a single service health maintenance organizationshall be a minimum of one hundred thousand dollars ($100,000) or such higheramount as the Commissioner shall determine to be adequate.
(b) In making thedeterminations required under this section, the Commissioner shall consider:
(1) The financialsoundness of the health care plan's arrangements for health care services andthe schedule of premiums used in connection therewith;
(2) The adequacy ofworking capital;
(3) Any agreement withan insurer, a hospital or medical service corporation, a government, or anyother organization for insuring the payment of the cost of health care servicesor the provision for automatic applicability of alternative coverage in theevent of discontinuance of the plan;
(4) Any agreement withproviders for the provision of health care services; and
(5) Any firm commitmentof federal funds to the health maintenance organization in the form of a grant,even though such funds have not been paid to the health maintenanceorganization, provided that the health maintenance organization certifies tothe Commissioner that such funds have been committed, that such funds are to bepaid to the health maintenance organization with a current fiscal year and thatsuch funds may be used directly for operating purposes and for the benefit ofenrollees of the health maintenance organization.
(c) A license shall bedenied only after compliance with the requirements of G.S. 58‑67‑155.(1977, c. 580,s. 1; 1979, c. 876, s. 1; 1983, c. 386, s. 2; 1987, c. 631, ss. 2, 4, 8; 1987(Reg. Sess., 1988), c. 975, s. 1; 2003‑212, s. 26(n).)
(a) Before issuing orcontinuing any such license, the Commissioner of Insurance may make such anexamination or investigation as he deems expedient. The Commissioner ofInsurance shall issue a license upon the payment of the application feeprescribed in G.S. 58‑67‑160 and upon being satisfied on thefollowing points:
(1) The applicant isestablished as a bona fide health maintenance organization as defined by thisArticle;
(2) The rates chargedand benefits to be provided are fair and reasonable;
(3) The amounts providedas working capital are repayable only out of earned income in excess of amountspaid and payable for operating expenses and expenses of providing services andsuch reserve as the Department of Insurance deems adequate, as providedhereinafter;
(4) That the amount ofmoney actually available for working capital be sufficient to carry allacquisition costs and operating expenses for a reasonable period of time fromthe date of the issuance of the license and that the health maintenanceorganization is financially responsible and may reasonably be expected to meetits obligations to enrollees and prospective enrollees. Such working capitalshall initially be a minimum of one million five hundred thousand dollars($1,500,000) for any full service medical health maintenance organization.Initial working capital for a single service health maintenance organizationshall be a minimum of one hundred thousand dollars ($100,000) or such higheramount as the Commissioner shall determine to be adequate.
(b) In making thedeterminations required under this section, the Commissioner shall consider:
(1) The financialsoundness of the health care plan's arrangements for health care services andthe schedule of premiums used in connection therewith;
(2) The adequacy ofworking capital;
(3) Any agreement withan insurer, a hospital or medical service corporation, a government, or anyother organization for insuring the payment of the cost of health care servicesor the provision for automatic applicability of alternative coverage in theevent of discontinuance of the plan;
(4) Any agreement withproviders for the provision of health care services; and
(5) Any firm commitmentof federal funds to the health maintenance organization in the form of a grant,even though such funds have not been paid to the health maintenanceorganization, provided that the health maintenance organization certifies tothe Commissioner that such funds have been committed, that such funds are to bepaid to the health maintenance organization with a current fiscal year and thatsuch funds may be used directly for operating purposes and for the benefit ofenrollees of the health maintenance organization.
(c) A license shall bedenied only after compliance with the requirements of G.S. 58‑67‑155.(1977, c. 580,s. 1; 1979, c. 876, s. 1; 1983, c. 386, s. 2; 1987, c. 631, ss. 2, 4, 8; 1987(Reg. Sess., 1988), c. 975, s. 1; 2003‑212, s. 26(n).)
(a) Before issuing orcontinuing any such license, the Commissioner of Insurance may make such anexamination or investigation as he deems expedient. The Commissioner ofInsurance shall issue a license upon the payment of the application feeprescribed in G.S. 58‑67‑160 and upon being satisfied on thefollowing points:
(1) The applicant isestablished as a bona fide health maintenance organization as defined by thisArticle;
(2) The rates chargedand benefits to be provided are fair and reasonable;
(3) The amounts providedas working capital are repayable only out of earned income in excess of amountspaid and payable for operating expenses and expenses of providing services andsuch reserve as the Department of Insurance deems adequate, as providedhereinafter;
(4) That the amount ofmoney actually available for working capital be sufficient to carry allacquisition costs and operating expenses for a reasonable period of time fromthe date of the issuance of the license and that the health maintenanceorganization is financially responsible and may reasonably be expected to meetits obligations to enrollees and prospective enrollees. Such working capitalshall initially be a minimum of one million five hundred thousand dollars($1,500,000) for any full service medical health maintenance organization.Initial working capital for a single service health maintenance organizationshall be a minimum of one hundred thousand dollars ($100,000) or such higheramount as the Commissioner shall determine to be adequate.
(b) In making thedeterminations required under this section, the Commissioner shall consider:
(1) The financialsoundness of the health care plan's arrangements for health care services andthe schedule of premiums used in connection therewith;
(2) The adequacy ofworking capital;
(3) Any agreement withan insurer, a hospital or medical service corporation, a government, or anyother organization for insuring the payment of the cost of health care servicesor the provision for automatic applicability of alternative coverage in theevent of discontinuance of the plan;
(4) Any agreement withproviders for the provision of health care services; and
(5) Any firm commitmentof federal funds to the health maintenance organization in the form of a grant,even though such funds have not been paid to the health maintenanceorganization, provided that the health maintenance organization certifies tothe Commissioner that such funds have been committed, that such funds are to bepaid to the health maintenance organization with a current fiscal year and thatsuch funds may be used directly for operating purposes and for the benefit ofenrollees of the health maintenance organization.
(c) A license shall bedenied only after compliance with the requirements of G.S. 58‑67‑155.(1977, c. 580,s. 1; 1979, c. 876, s. 1; 1983, c. 386, s. 2; 1987, c. 631, ss. 2, 4, 8; 1987(Reg. Sess., 1988), c. 975, s. 1; 2003‑212, s. 26(n).)
