Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 12 - HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS › Chapter 31.12.01 - Health Maintenance Organizations - Certificate of Authority and Fiscal Requirements › Section 31.12.01.04 - Application for Certificate of Authority

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Act provides that an HMO may not engage in business as an HMO unless so authorized under a certificate of authority issued by the Insurance Commissioner.
B. Application for a certificate of authority shall be submitted by the HMO not less than 90 days before the date it proposes to engage in business in this State.
C. An application form will be furnished by the Commissioner on the request of the HMO.
D. Each health maintenance organization, as defined in Health-General Article, §19-701(e), Annotated Code of Maryland, seeking a certificate of authority to transact business in Maryland shall file the following items:
(1) A copy of the basic organizational document of the HMO and any amendments to it, certified if applicable, by the Department of Assessments and Taxation.
(2) A copy of the HMO's current bylaws, if any, certified by the appropriate officer of the HMO.
(3) A list of the names, addresses, and official capacity with the HMO of the persons who are to be responsible for the conduct of its affairs, including all members of the governing body, the officers and directors in the case of a corporation, and the partners or associates in the case of a partnership or association. These persons shall disclose fully to the Commissioner and the governing body of the HMO the extent and nature of any contracts or arrangements between them and the HMO, including any possible conflicts of interest.
(4) A resume of the qualifications of the administrator, the medical director, the enrollment director, and of other persons associated with the HMO as requested by the Commissioner and the Department of Health and Mental Hygiene.
(5) A statement generally describing the:
(a) HMO;
(b) HMO's operations;
(c) HMO's enrollment process;
(d) HMO's quality assurance mechanism;
(e) HMO's internal grievance procedures;
(f) Methods the HMO proposes to use to offer its members or public representatives an opportunity to participate in matters of policy and operation;
(g) Location of the facilities at which health care services will be regularly available to members;
(h) Type and specialty of physicians and health care personnel engaged to provide health care services;
(i) Number of physicians and personnel in each category;
(j) Health and medical records system to provide documentation of utilization by members.
(6) Forms of all health maintenance contracts the HMO proposes to offer to subscribers showing the benefits to which they are entitled, together with a table of the rates charged, or proposed to be charged, for each form of contract.
(7) A statement describing with reasonable certainty the geographic area or areas to be served by the HMO.
(8) A certified statement of the financial condition of the HMO, including:
(a) Sources of financial support;
(b) Assets and liabilities and minimum tangible net equity;
(c) Other financial information the Commissioner requires for adequate financial evaluation.
(9) Copies of proposed advertising and proposed techniques and methods of marketing the services of the HMO.
(10) A power of attorney duly executed by the HMO appointing the Commissioner and his duly authorized deputies, as the true and lawful attorney of the HMO in and for the State upon whom may be served all lawful process in any action, proceeding, or cause of action arising in this State against the HMO.
(11) A certificate of compliance evidencing employee coverage under Workers' Compensation law (Labor and Employment Article, Title 9, Annotated Code of Maryland).
(12) An official written notification from the Department of Health and Mental Hygiene that the HMO's proposed health-related services, operations, and functions falling under the regulatory jurisdictions of the Department appear to meet its requirements and have been approved by the Department in accordance with its regulations.