Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-79 - HEALTH PLAN PURCHASING COOPERATIVES
Rule 120-2-79-.04 - Application and Issuance of Certificate of Authority

Universal Citation: GA Rules and Regs r 120-2-79-.04

Current through Rules and Regulations filed through September 23, 2024

(1) It is unlawful for any person or entity to act as or hold itself out to be a health plan purchasing cooperative in this State without a valid certificate of authority issued by the Commissioner of Insurance. To qualify for and hold a certificate of authority to act as a health plan purchasing cooperative in this State, a health plan purchasing cooperative must otherwise be in compliance with O.C.G.A. § 33-30A-1et seq., this Regulation Chapter, and the bylaws of the health plan purchasing cooperative.

(2) The health plan purchasing cooperative shall file with the Commissioner an application for a certificate of authority upon a form to be furnished by the Commissioner. The application shall include or have attached the following information and documents:

(a) All basic organizational documents of the health plan purchasing cooperative including certificate of existence, the articles of incorporation, and other applicable documents, and all amendments to those documents;

(b) The bylaws, rules and regulations, statements of policy or similar documents regulating the conduct or the internal affairs of the health plan purchasing cooperative;

(c) The names, addresses, official positions, and professional qualifications of the individuals who are responsible for the conduct of the affairs of the health plan purchasing cooperative, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers of the corporation, the membership of any advisory group or groups, and any other person who exercises control or influence over the affairs of the health plan purchasing cooperative;

(d) Audited annual statements or reports for each of the three most recent years, compiled by a certified public accountant, or such other information as the Commissioner may require in order to review the current financial condition of the applicant which ultimately reflects a minimum net worth amount of $200,000;

(e) If the applicant is not currently acting as a health plan purchasing cooperative, a statement of the amounts and sources of the funds available for organizational expenses and the proposed arrangements for reimbursement and compensation of incorporators or other principals;

(f) Fees required of a health plan purchasing cooperative as provided in the application materials;

(g) A business plan detailing the operation of the health plan purchasing cooperative in Georgia that includes the applicant's method(s) of solicitation, names of insurers and insurance products offered through the cooperative and the geographic area(s) the health plan purchasing cooperative is intending to serve;

(h) A copy of the guarantee of uninterrupted coverage as stipulated by O.C.G.A. § 33-30A-8(c); and

(i) Copies of all agreements between the health plan purchasing cooperative and the carrier(s) as stipulated by O.C.G.A. § 33-30A-4(f) as well as any administrator agreement(s) and/or agent agreement(s) used in the operations of the applicant.

(3) The applicant shall make available for inspection by the Commissioner or his or her authorized representative copies of all contracts with participating carriers or members of the health plan purchasing cooperative.

(4) The Commissioner may not issue a certificate of authority if he or she determines that the health plan purchasing cooperative, or any principal thereof is not competent, trustworthy, financially responsible, has worked as a responsible officer of an insurer whose certificate of authority was refused, revoked, or suspended, has had an agent's license refused, revoked, or suspended by any state, or, pursuant to O.C.G.A. § 33-30A-7(d), has or had a financial interest in the operations of the health plan purchasing cooperative. As partial verification, the applicant is required to submit an investigative background report, supplied by any outside agency, directly to the department to support individual biographical affidavit(s) submitted by all directors, officers and/or principals representing the applicant. The report must include 10 years of data with specific review of all local, state and federal courts in areas where the individual has resided. Furthermore, the report should contain a credit report on the individual.

(5) A certificate of authority issued under this section shall remain valid, unless suspended or revoked by the Commissioner, so long as the health plan purchasing cooperative continues in business in this state in compliance with O.C.G.A. Title 33, Chapter 30A and this Regulation Chapter, and annually renews its certificate of authority in a timely manner.

(6) A health plan purchasing cooperative shall, as part of its application for licensure, disclose its written conditions of membership referred to in O.C.G.A. § 33-30A-4(b)(1) to the Commissioner for approval. Any material change to such conditions shall also be filed with the Commissioner for approval at least sixty (60) days prior to use.

O.C.G.A. Secs. 33-2-9, 33-30A-4, 33-30A-5, 33-30A-7, 33-30A-8, 33-30A-9.

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