KRS 304.38-040: Establishment of health maintenance organizations.

(1) A corporation, limited liability company, or partnership may apply to the

commissioner for and obtain a certificate of authority to establish and operate a

health maintenance organization in compliance with this subtitle.

(2) Health maintenance organizatio ns which are corporations may be organized by

applying the provisions of KRS Chapter 271B, if for profit, and KRS Chapter 273,

if for nonstock, nonprofit, to the extent that the same are not inconsistent with the

express provisions of this subtitle.

(3) Each application for a certificate of authority shall be submitted to the

commissioner upon a form prescribed by the commissioner and shall set forth or be

accompanied by:

(a) Evidence that the applicant has been issued a certificate of need in accordance

with the provisions of KRS Chapter 216B or evidence that no certificate of

need is required by KRS Chapter 216B;

(b) Articles of incorporation, articles of organization, partnership agreement, or

other applicable documents in quadruplicate, acknowledged and verified by

the applicant;

(c) The initial bylaws, operating agreement, or other equivalent documents of the

organization in triplicate, or any other similar documents;

(d) A statement which shall include describing the health maintenance

organization:

1. The health services to be offered;

2. The financial risks to be assumed;

3. The initial geographic area to be served;

4. Pro forma financial projections for the first three (3) years of operations

including the assumptions the projections are based upon;

5. The sources of working capital and funding;

6. A description of the persons to be covered by the health maintenance

organization;

7. Any proposed reinsurance arrangements;

8. Any proposed management, administrative, or cost -sharing

arrangements; and

9. A description of the health maintenance organization's proposed method

of marketing;

(e) The names, addresses, and positions of the initial board of directors, board of

trustees, or other governing body responsible for the conduct of the affairs of

the applicant;

(f) Any proposed evidence of coverage to be issued by the applicant to

individuals, enrollees, groups, or other contract holders; and

(g) Evidence of financial responsibility as provided in KRS 304.38-060.