Application for certificate of authority, content.
354.704. An application for a certificate of authority tooperate a prepaid dental plan corporation in this state shall befiled with the director on a form prescribed by the director.Such application shall be verified by an officer or authorizedrepresentative of the applicant and shall set forth, or beaccompanied by, the following:
(1) A duly certified copy of the corporation's articles ofincorporation or articles of association with all amendments;
(2) A copy of the corporation's bylaws or regulationsgoverning the conduct of the internal affairs of the corporation;
(3) A list of the names, addresses, and official positionsof the persons who are responsible for the conduct of the affairsof the corporation, including all members of the board ofdirectors;
(4) A copy of any contract made or to be made between anyproviders and the applicant;
(5) A statement generally describing the prepaid dental planto be offered and the corporation's facilities and personnel;
(6) A copy of contracts and contract certificates to beissued to the enrollees;
(7) A copy of any group enrollee contract which is to beissued;
(8) Financial statements showing the applicant's assets,liabilities, and sources of financial support. If theapplicant's financial affairs are audited by independentcertified public accountants, a copy of the applicant's mostrecent regular certified financial statement shall satisfy thisrequirement unless the director determines that additional ormore recent financial information is required;
(9) A description of the proposed method of marketing theprepaid dental plan, a financial plan which includes a three-yearprojection of the initial operating results anticipated, and astatement as to the sources of funding;
(10) A description of the procedures to provide emergencydental benefits;
(11) A statement reasonably describing the geographic areato be served;
(12) A fee of two hundred dollars for issuance of acertificate of authority; and
(13) Such other information as the director may require.
Application for certificate of authority, content.
354.704. An application for a certificate of authority tooperate a prepaid dental plan corporation in this state shall befiled with the director on a form prescribed by the director.Such application shall be verified by an officer or authorizedrepresentative of the applicant and shall set forth, or beaccompanied by, the following:
(1) A duly certified copy of the corporation's articles ofincorporation or articles of association with all amendments;
(2) A copy of the corporation's bylaws or regulationsgoverning the conduct of the internal affairs of the corporation;
(3) A list of the names, addresses, and official positionsof the persons who are responsible for the conduct of the affairsof the corporation, including all members of the board ofdirectors;
(4) A copy of any contract made or to be made between anyproviders and the applicant;
(5) A statement generally describing the prepaid dental planto be offered and the corporation's facilities and personnel;
(6) A copy of contracts and contract certificates to beissued to the enrollees;
(7) A copy of any group enrollee contract which is to beissued;
(8) Financial statements showing the applicant's assets,liabilities, and sources of financial support. If theapplicant's financial affairs are audited by independentcertified public accountants, a copy of the applicant's mostrecent regular certified financial statement shall satisfy thisrequirement unless the director determines that additional ormore recent financial information is required;
(9) A description of the proposed method of marketing theprepaid dental plan, a financial plan which includes a three-yearprojection of the initial operating results anticipated, and astatement as to the sources of funding;
(10) A description of the procedures to provide emergencydental benefits;
(11) A statement reasonably describing the geographic areato be served;
(12) A fee of two hundred dollars for issuance of acertificate of authority; and
(13) Such other information as the director may require.
Application for certificate of authority, content.
354.704. An application for a certificate of authority tooperate a prepaid dental plan corporation in this state shall befiled with the director on a form prescribed by the director.Such application shall be verified by an officer or authorizedrepresentative of the applicant and shall set forth, or beaccompanied by, the following:
(1) A duly certified copy of the corporation's articles ofincorporation or articles of association with all amendments;
(2) A copy of the corporation's bylaws or regulationsgoverning the conduct of the internal affairs of the corporation;
(3) A list of the names, addresses, and official positionsof the persons who are responsible for the conduct of the affairsof the corporation, including all members of the board ofdirectors;
(4) A copy of any contract made or to be made between anyproviders and the applicant;
(5) A statement generally describing the prepaid dental planto be offered and the corporation's facilities and personnel;
(6) A copy of contracts and contract certificates to beissued to the enrollees;
(7) A copy of any group enrollee contract which is to beissued;
(8) Financial statements showing the applicant's assets,liabilities, and sources of financial support. If theapplicant's financial affairs are audited by independentcertified public accountants, a copy of the applicant's mostrecent regular certified financial statement shall satisfy thisrequirement unless the director determines that additional ormore recent financial information is required;
(9) A description of the proposed method of marketing theprepaid dental plan, a financial plan which includes a three-yearprojection of the initial operating results anticipated, and astatement as to the sources of funding;
(10) A description of the procedures to provide emergencydental benefits;
(11) A statement reasonably describing the geographic areato be served;
(12) A fee of two hundred dollars for issuance of acertificate of authority; and
(13) Such other information as the director may require.
