RELATES TO:
KRS
304.38-060
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
304.38-060 provides that applicant Health
Maintenance Organizations satisfy the commissioner as to the reputation and
capability of persons responsible for the conduct of its affairs, its financial
responsibility and its financial basis in provisions for working capital prior
to the issuance of a certificate of authority.
Section 1. The proposed health maintenance
organization shall furnish the name and residence address of each individual
who will be directors, officers or management of the health maintenance
organization. A biographical resume must be furnished on each individual on a
form prescribed by the commissioner.
Section
2. The health maintenance organization shall have sufficient funds
originally to cover all initial organizational, promotional, and sales
expenses, plus an additional amount sufficient to cover up to thirty (30) days
operating expenses.
Section 3. The
health maintenance organization shall cease issuing new contracts to enrollees,
except newborn children or other newly acquired dependents of existing
enrollees, when its admitted assets are less than $80,000 in excess of its
liabilities. The aforesaid shall not apply for the first thirty-six (36) months
of operation under a certificate of authority for those health maintenance
organizations which have no other source of funding for operating costs, except
for revenues received from enrollees or revenues received thereon, other than
through loans or loan guarantees which have been granted by the United States
under Title XII of the Health Maintenance Act of 1973 Section 1305.
Section 4. In order to help determine the
financial responsibility of the health maintenance organization, it will be
necessary for each health maintenance organization to furnish financial
statements, for three (3) years after the certificate of authority has been
issued, to the commissioner on a calendar quarter basis, i.e., as of March 31,
June 30, September 30 and December 31. These statements shall be filed upon a
form prescribed by the commissioner no later than forty-five (45) days
following the close of the calendar quarter. At the end of the three (3) year
period as noted above, the commissioner may request the continuation of such
quarterly reporting if he deems it necessary.
