RELATES TO:
KRS
304.38-040
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
304.38-040 provides that a health maintenance
organization supply the commissioner information upon application for
certificate of authority. This administrative regulation explains the
authenticity of the health maintenance organization's financial projections and
possibility of overlapping health maintenance organizations within a particular
geographic area.
Section 1. The three
(3) year projections for the financial program of the applicant health
maintenance organization shall be prepared by an individual who has satisfied
the commissioner by virtue of his training, education and experience that he is
qualified to make such projections.
Section
2. The existence or proposed operation of health maintenance
organizations in the same geographic area that could affect the number of
prospective enrollees of the applicant health maintenance organization shall be
disclosed to the commissioner in the description of the initial geographic area
to be served.
Section 3. In noting
the sources of working capital and funding, the proposed health maintenance
organization shall inform the commissioner whether there are grants, loans or
loan guarantees from the federal government; if so, the amounts thereof, rates
of interest, if any, the schedule of repayment, if any, of the principal and
interest. If the working capital and funding is derived from other than through
the federal government, indicate such source, giving details of such program,
including any schedule of repayments of principal and interest on loans which
may have been made.
