93(2) 94An application for a license to operate as a discount plan organization must be filed with the office on a form prescribed by the commission. Such application must be sworn to by an officer or authorized representative of the applicant and be accompanied by the following, if applicable:142(a) 143A copy of the applicant’s articles of incorporation or other organizing documents, including all amendments.
158(b) 159A copy of the applicant’s bylaws.
165(c) 166A list of the names, addresses, official positions, and biographical information of the individuals who are responsible for conducting the applicant’s affairs, including, but not limited to, all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the officers, contracted management company personnel, and any person or entity owning or having the right to acquire 10 percent or more of the voting securities of the applicant. Such listing must fully disclose the extent and nature of any contracts or arrangements between any individual who is responsible for conducting the applicant’s affairs and the discount plan organization, including any possible conflicts of interest.
276(d) 277A complete biographical statement on forms prescribed by the commission, an independent investigation report, and a set of fingerprints, as provided in chapter 624, with respect to each individual identified under paragraph (c).
310(e) 311A statement generally describing the applicant, its facilities and personnel, and the medical services to be offered.
328(f) 329A copy of the form of all contracts made or to be made between the applicant and any providers or provider networks regarding the provision of medical services to members.
359(g) 360A copy of the form of any contract made or arrangement to be made between the applicant and any person listed in paragraph (c).
384(h) 385A copy of the form of any contract made or to be made between the applicant and any person, corporation, partnership, or other entity for the performance on the applicant’s behalf of any function, including, but not limited to, marketing, administration, enrollment, investment management, and subcontracting for the provision of health services to members.
439(i) 440A copy of the applicant’s most recent financial statements audited by an independent certified public accountant. An applicant that is a subsidiary of a parent entity that is publicly traded and that prepares audited financial statements reflecting the consolidated operations of the parent entity and the subsidiary may petition the office to accept, in lieu of the audited financial statement of the applicant, the audited financial statement of the parent entity and a written guaranty by the parent entity that the minimum capital requirements of the applicant required by this part will be met by the parent entity.
538(j) 539A description of the proposed method of marketing.
547(k) 548A description of the subscriber complaint procedures to be established and maintained.
560(l) 561The fee for issuance of a license.
568(m) 569Such other information as the commission or office may reasonably require to make the determinations required by this part.
