Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 31 - Miscellaneous › Article 5 - Air Ambulance Services › 3 AAC 31.610 - Provider registration

Current through May 31, 2024
(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.