Rules & Regulations of the State of Tennessee
Title 0780 - Commerce and Insurance
Subtitle 0780-01 - Insurance Division
Chapter 0780-01-76 - Self-Insurance Associations and Non-Profit Business Coalitions for Health
Section 0780-01-76-.05 - APPLICATION FOR A CERTIFICATE OF AUTHORITY
Universal Citation: TN Comp Rules and Regs 0780-01-76-.05
Current through September 24, 2024
(1) To apply for a certificate of authority, an arrangement shall file with the Commissioner an application on a form adopted by the Commissioner, accompanied by a fee as set under Tenn. Code Ann. §56-4-101(a)(1), showing its name, the location of its home office, its date of organization, its state of domicile, and additional information that the Commissioner may reasonably require in order to determine an arrangement's qualifications to obtain a certificate of authority hereunder.
(2) The application shall be submitted together with:
(a) A copy of all articles,
bylaws, agreements, trusts, or other documents or instruments describing the
rights and obligations of the employers, employees, and beneficiaries of the
arrangement;
(b) A copy of each
summary plan description of the arrangement filed or required to be filed with
the United States Department of Labor, including any amendments to each
description;
(c) Evidence of
coverage of or letter of intent to participate executed by at least ten (10)
employers providing allowable benefits;
(d) Financial statements for the preceding
five (5) fiscal years or for such lesser period as such applicant shall have
been in existence, and similar information covering the period from the end of
such person's last fiscal year, if the information is available.
1. The financial statements of the applicant
shall be accompanied by the certificate of an independent public accountant to
the effect that such statements present fairly the financial position of the
applicant and the results of its operations for the year then ended, in
conformity with the National Association of Insurance Commissioners Accounting
Practices and Procedures Manual.
(e) Proof that the arrangement maintains and
will continue to maintain fidelity bonds required by the United States
Department of Labor under 29 U.S.C. 1001 - 1461 (Employee Retirement Income
Security Act of 1974);
(f) A copy
of any stop-loss insurance policies maintained or proposed to be maintained by
the arrangement;
(g) Biographical
reports, on forms prescribed by the National Association of Insurance
Commissioners, evidencing the general trustworthiness and competence of each
individual who is serving or who will serve as a managing employee or fiduciary
of the arrangement;
(h) A notarized
statement executed by an officer of the arrangement certifying, to the best
knowledge and belief of the officer, that the information provided in the
application is true and correct and that the arrangement is in compliance with
the requirements in
1.29 U.S.C. 1001 - 1461
(Employee Retirement Income Security Act of 1974) or a statement of any
requirements with which the arrangement is not in compliance and a statement of
proposed corrective action; and
2.
Rule 0780-1-76-.06.
Authority: T.C.A. § 56-26-204(b).
Disclaimer: These regulations may not be the most recent version. Tennessee may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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