Alabama Administrative Code
Title 482 - ALABAMA DEPARTMENT OF INSURANCE
Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY
Section 482-1-079-.03 - Application

(1) An application, on forms provided by the Commissioner, accompanied by the greater of a filing fee of Fifty Dollars and a Commissioner's seal fee of Five Dollars (totaling $55.00) or the amount levied by the state of domicile, payable to the Commissioner, shall be completed by the responsible persons in each entity desiring to obtain a certificate of authority as a HMO. The application with a copy in duplicate shall be attested and notarized and be accompanied by biographical affidavits of the principal officers and directors, financial statements on the National Association of Insurance Commissioners HMO "convention" blank, and other supporting documents required by the application form and guidelines. Applicants shall address correspondence to the Examination Division, Alabama Department of Insurance, Montgomery, Alabama 36130. A copy of the application and supporting documents shall be filed with the Department of Public Health, Bureau of Licensure and Certification, Montgomery, Alabama 36130.

(2) Any material change in the plan of operations or any other section set out in the information filed with the application for admission shall be filed with the Commissioner and the State Health Officer prior to modification.

Author: Commissioner of Insurance