Or. Admin. Code § 836-200-0200 - License, Discount Medical Plan Organization; Renewal

(1) An applicant for a license to operate as a discount medical plan organization shall apply for the license by completing and submitting to the Director the application form prescribed by the Director. The application form shall request the information required by section 5, chapter 272, Oregon Laws 2007 and this rule.

(2) To enable the Director to determine whether an applicant is financially responsible, the application shall require the following information:

(a) Whether the applicant has ever filed for bankruptcy or been adjudged a bankrupt.

(b) An audited annual financial statement for the most recent year or alternatively, an unaudited financial statement and the applicable signed federal tax form of the applicant for the most recent year, to prove that the applicant is solvent and has a continuing income stream. An applicant may submit a consolidated financial statement if the statement clearly segregates and reports the affairs of the applicant. The applicable federal tax form for the purpose of this subsection is as follows:

(A) For an individual, Form 1040.

(B) For a corporation, Form 1120.

(C) For a subchapter S corporation, Form 1120S.

(D) For a partnership, Form 1065.

(E) For a limited liability company, the form that the company files for federal income tax purposes.

(c) If the applicant is a corporation that is newly formed for the purpose of transacting business as a discount medical plan organization, the statements and forms required under subsection (b) of this section as they may be available, and the applicant's business plan, including three years of projections of net worth, revenue, expenses and net income.

(3) To enable the Director to determine whether an applicant has adequate experience and expertise to operate a discount medical plan organization, an applicant shall indicate, as provided in the application, all states and provinces of Canada in which the applicant currently holds a license, registration or certificate of authority to transact business as a discount medical plan organization, or has held such a license or certificate within ten years prior to the date of the application.

(4) To enable the Director to determine whether an applicant is of good character, an applicant shall indicate, as provided in the application, whether any license or registration of the applicant to act in any occupational or professional capacity has ever been refused, revoked or suspended in this or any other state, and whether the applicant has otherwise ever been the subject of an enforcement action taken by a licensing or registration agency. If the applicant's answer is affirmative in any respect, the applicant must also provide the name and address of the licensing or registration agency, the date of the complaint or the action taken against the license or registration, a description of the nature of the complaint or the reason for the action taken against the license or registration, and, with regard to a complaint, a description of the licensing or registering agency's disposition of the complaint.

(5) In addition to the requirements of sections (3) and (4) of this rule, to enable the Director further to determine whether an applicant has adequate experience and expertise to operate a discount medical plan organization and whether an applicant is of good character, an applicant shall submit with the application a copy of the NAIC biographical affidavit, completed by the following individuals:

(a) Each member of the board of directors, executive committee or other governing board or committee of the discount medical plan organization;

(b) Each principal officer in the case of a corporation or each partner or member in the case of a partnership or association who holds an interest of ten percent or more in the partnership or association; and

(c) Each shareholder holding directly or indirectly ten percent or more of the voting securities of the discount medical plan organization.

(6) A licensee must renew a license by submitting to the Director a completed license renewal application on the form prescribed by the Director, not later than the 30th day after receiving a notice of renewal from the Director.

Notes

Or. Admin. Code § 836-200-0200

ID 5-2008, f. & cert. ef. 4-14-08

Stat. Auth.: ORS 731.244 & 742.426

Stats. Implemented: ORS 742.426