Current through Register Vol. XLI, No. 38, September 20, 2024
3.1. All
Discount Medical Plan Organizations must obtain a license pursuant to W. Va. Code
§
33-15E-4 and
this rule to continue conducting business and prior to commencing operations in the
state of West Virginia.
3.2. A person or
entity must submit the following to obtain a license to conduct business as a
Discount Medical Plan Organization:
3.2.a. A fully
completed Discount Medical Plan Organization Application for License (Form
DMP-1);
3.2.b. A $300 non-refundable
application fee;
3.2.c. An original
certificate of authority from the state of domicile;
3.2.d. Copies of all registration documents and
licenses required by the State of West Virginia;
3.2.e. Articles of Incorporation and
by-laws;
3.2.f. A description of the
proposed method of marketing, including types of discounts to be offered and the
advertising media to be used, including the procedures in place to approve
advertising, prior to use;
3.2.g. An
audited financial statement prepared in accordance with generally accepted
accounting principals certified by an independent certified public accountant,
including the balance sheet, income statement and statement of changes in cash flow
for the preceding year or if an affiliate of a parent entity that is publicly
traded, those audited financial statements and a written guarantee that the minimum
capital as set forth in W. Va. Code §
33-15E-5
will be met by the parent entity;
3.2.h.
List of names, official positions and addresses of all persons responsible for the
conduct of the organization's affairs, including company officers, directors and
shareholders owning ten percent or more shares in the organization;
3.2.i. The number of discount medical plan members
in the state;
3.2.j. A copy of the form
of all provider agreements offering medical or ancillary services to its
members;
3.2.k. A list of all
participating pharmacies offering discounts on prescription drugs to plan members or
an Internet website address where such a list can be accessed by the
Commissioner;
3.2.l. Organization chart
including all entities within the ultimate parent company structure, if
applicable;
3.2.m. Biographical
affidavits for company officers, directors and shareholders owning ten percent or
more shares in the organization;
3.2.n.
Proof of compliance with the net worth requirement of $150,000; and
3.2.o. A surety bond in an amount not less than
$35,000 for the benefit of any person that is damaged by any violation of W. Va.
Code §33-15E, et seq. and this rule.
3.2.p. A description of the member complaint
procedures.
3.3. Any
incomplete application, as determined by the Commissioner, that remains incomplete
for a period of four months will be considered withdrawn and a new application and
new application fees are required.
3.4.
The license of a Discount Medical Plan Organization must be renewed annually on or
before the thirty first day of May next following the date of issuance. The renewal
fee shall be in an amount of $100. If a Discount Medical Plan Organization fails to
pay the renewal fee, the nonpayment shall result in a lapse of the license. A
Discount Medical Plan Organization that allows its license to lapse may, within
twelve months from the due date of the renewal fee, reinstate the same license,
however, a penalty in the amount of $100 shall be required for any renewal fee
received after the due date.
3.5. Along
with the renewal fee, each licensee shall provide the Commissioner with the
following in order to renew their license:
3.5.a.
An audited financial statement prepared in accordance with generally accepted
accounting principals certified by an independent certified public accountant,
including the balance sheet, income statement and statement of changes in cash flow
for the preceding year. If the Discount Medical Plan Organization is an affiliate of
a parent entity that is publicly traded, those audited financial statements and a
written guarantee that the minimum capital will be met by the parent
entity;
3.5.b. Any changes in the list
of names and addresses of all persons responsible for the conduct of the
organization's affairs, including company officers, directors and shareholders
owning ten percent or more shares in the organization;
3.5.c. The number of discount medical plan members
in the state; and
3.5.d. Proof of
compliance with the net worth requirement of $150,000.
3.6. The Insurance Commissioner may waive any
requirement for a Discount Medical Plan Organization license for an applicant with a
valid license from the organization's home state if the applicant's home state
awards nonresident licenses to residents of this state on a reciprocal
basis.
3.7. In the event a problem
occurs with a particular provider, the Discount Medical Plan Organization shall
provide that particular provider agreement to the Commissioner upon request by the
Commissioner.
