3 AAC 31.610 - Provider registration

(a) A person may not sell, solicit, or negotiate a membership agreement in this state unless registered as a provider under this section. Initial provider registration applications may be filed at any time. Renewal provider registration applications shall be filed on or before June 1 of the year the provider's current provider biennial registration period ends.

(b) An initial provider registration application must include

(1) payment of the initial biennial registration application fee under 3 AAC 31.060( a)(32);

(2) a completed provider registration application form prescribed by the director that includes the

(A) name of each state in which the applicant is authorized to offer membership agreements;

(B) name of the state in which the applicant is domiciled;

(C) name of the applicant;

(D) "doing business as" name of the applicant;

(E) complete physical address, mailing address, electronic mail address, phone number, and facsimile number of the

(i) applicant's principal place of business in the applicant's state of domicile; and

(ii) applicant's principal place of business in this state;

(F) electronic mail address the applicant wants the division to use to communicate with the applicant;

(G) internet address of the applicant; and

(H) federal employer identification number of the applicant;

(3) a copy of the business license issued to the applicant by the department;

(4) for registrations filed

(A) before January 1, 2017, audited or reviewed financial statements for each of the preceding two calendar years;

(B) on or after January 1, 2017, audited financial statements for each of the preceding two calendar years;

(5) a biographical information affidavit for each officer, director, and individual acting in a fiduciary capacity that includes

(A) the affiant's full name;

(B) the physical address, mailing address, electronic mail address, telephone number, and facsimile number where the affiant works;

(C) the affiant's employment record for the past ten years which includes for each office and position held the

(i) affiant's title;

(ii) beginning and ending dates;

(iii) employer's name, address, and telephone number;

(iv) type of business; and

(v) name of the affiant's supervisor or contact person;

(D) any judicial, administrative, regulatory, or disciplinary action during the past ten years taken against any occupational, professional, or vocational license or permit the affiant holds or has held;

(E) any guilty or nolo contendere plea, or conviction of a crime during the past ten years, other than a minor traffic violation; and

(F) any civil action in which the affiant is or was a party during the past ten years involving dishonesty, breach of trust, or a financial dispute;

(6) a plan of operation satisfactory to the director that demonstrates the applicant has the financial resources necessary to sustain operations for at least two years with qualified staff at the proposed level of service and in the proposed service area or areas;

(7) a plan demonstrating actions the applicant will take should the applicant cease operations;

(8) a copy of each proposed membership agreement, proposed fee or other consideration, and the expected ratio of the total annual membership benefits to the total amount of annual considerations;

(9) all agreements directly or indirectly associated with membership agreements including reciprocal provider agreements, aircraft lease agreements, and service contracts;

(10) a certification issued by the Department of Health and Social Services under AS 18.08.082(a)(3); and

(11) a detailed description of any criteria used in determining who is eligible for a membership agreement.

(c) In complying with (b)(5)(D), (E), and (F) of this section, no response is required if a record has been sealed or expunged, and the affiant has personally verified that the record was sealed or expunged. If a response is required, the affiant shall provide the and

(1) nature of the action or crime;

(2) date;

(3) location; and

(4) disposition.

(d) A renewal provider registration application must include

(1) the renewal biennial registration application fee under 3 AAC 31.060(a)(33);

(2) all of the requirements under (b)(2)-(11), and (c) of this section.

(e) If a change occurs in the information submitted to the director in a registration application, a provider shall update the information in the registration application by sending the changes to the director in writing not later than 30 days after the change. If an officer, director, or person acting in a fiduciary capacity is appointed after the registration application has been filed with the director, the provider shall file a biographical information affidavit not later than 30 days after the appointment of the person.

(f) The following information received by the director under this section is confidential and not subject to public inspection:

(1) biographical information affidavits;

(2) information that is confidential under AS 21.06.060.

Notes

3 AAC 31.610

Eff. 11/26/2015, Register 216, January 2016

Authority:AS 21.06.060

AS 21.06.090

AS 21.36.355

AS 21.61.105

AS 21.61.109