RULE 054.00.95-002 - Reg. 35 - Emergency - Agent License for Health Maintenance Organizations

RULE 054.00.95-002. Reg. 35 - Emergency - Agent License for Health Maintenance Organizations

SECTION 1. PURPOSE

The purpose of this Emergency Rule is to set the standards and guidelines under which agents for Health Maintenance Organizations ("HMO") can be licensed by the State of Arkansas.

SECTION 2. AUTHORITY: EMERGENCY ADOPTION

The authority for this Emergency Rule is the power given to the Insurance Commissioner for the State of Arkansas by Ark. Code Ann. §§ 23-61-108, 23-76-120, and the emergency adoption provisions of the Administrative Procedure Act, § 25-15-204(b), et seq.

SECTION 3. EFFECTIVE DATE: EMERGENCY

It is hereby declared that the immediate adoption of this Rule is necessary to implement and clarify the provisions of Ark. Code Ann. § 23-76-120, as to nonresident HMO agent licensure. Immediate adoption is necessary to prevent imminent peril to the public health, safety or welfare to the citizens of this State. Therefore the provisions of this Emergency Rule shall become effective immediately upon signature by the Commissioner and filing. The Emergency Rule shall expire one hundred and twenty (120) days from its effective date, unless sooner replaced with a permanent Rule adopted by the Commissioner after public notice and a hearing.

SECTION 4. APPLICABILITY AND SCOPE '

This Emergency Rule shall apply to all persons engaged in the business of marketing contracts, soliciting enrollments, or offering memberships with a Health Maintenance Organization.

SECTION 5. DEFINITIONS

a) "Agent" means any person who engages in solicitation and enrollment for any Health Maintenance Organization, but shall

* exclude any salaried officer or employee who has duties that are primarily administrative and who receives no commission for applications taken or enrollments made.

b) "Applicant" means any person, firm or corporation who has applied for a certificate of authority as a Health Maintenance Organization.

SECTION 6. LICENSE QUALIFICATIONS

a) Every person applying for an agent license shall be qualified as follows:

(1) Must be of legal age. *

(2) Must be a resident of this state or a licensed non-resident.

(3) 'Must be appointed by a licensed Health" Maintenance Organization or an applicant for said license.

(4) Must be deemed by the Commissioner to be competent,

trustworthy, financially responsible and of good personal and business reputation.

(5) Must pass such written examination as required by the Commissioner.

SECTION 7. FEES

a) There shall be a Thirty Dollar ($30.00) examination fee paid to the Commissioner prior to the examination, and a $30.00 retake fee.

b) There shall be a Twenty-Five Dollar ($25.00) licensing fee paid to the Commissioner for the issuance of an agent's license.

c) There shall be a Twenty-Five Dollar ($25.00) renewal fee paid to the Commissioner for the renewal of an agent's license.

d) There shall be a Thirty-five Dollar ($35.00) regulatory fee (ALF fee) due annually from each licensee per Commissioner's Rule 57.

SECTION 8. TERM OF LICENSE

Every license issued under this Emergency Rule shall be valid for the calendar year when issued and must be renewed annually. Licenses will be renewed when the Department receives written notice and agent appointments from the HMO of its' intent to have its agents' licenses continued.

SECTION 9. REVOCATION AND SUSPENSION OF LICENSE

a) The Commissioner may suspend, for not more than twelve (12) months, or may revoke or refuse to continue any license issued under this Emergency Rule after notice to the licensee and a hearing is held under the provisions of Ark Code Ann. §§ 23-61-303, et seq., and the Commissioner finds that any one or more of the following causes exist:

(1) Any cause for which issuance of the license could have been refused had it then existed and been known to the Commissioner.

(2) Violation of or noncompliance with any provision of the insurance code, or for willful violation of any rule, regulation or order of the Commissioner.

(3) Obtaining or attempting to obtain any such license through fraud or misrepresentation.

(4) Misappropriation or conversion to his.- own use any moneys received through the course of business that do not belong to him.

(5) Conviction of a felony.

(6) If in the conduct of his affairs, the licensee has used fraudulent, or dishonest practices, or trade practices prohibited by the insurance code.

b) If the Commissioner finds that any one (1) or more grounds exist for the suspension or revocation of any license, the Commissioner may in his discretion, in lieu of such suspension or revocation, impose an administrative penalty in the amount of three hundred dollars ($300), or if the Commissioner has found willful misconduct or willful violation by the licensee, one thousand dollars ($1,000).

SECTION 10. SEVERABILITY

Any section or provision of this Emergency Rule held by a court to be invalid or unconstitutional will not affect the validity of any other section or provision of this rule.

(6/21/1995)

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