KRS 304.38-060: Issuance of certificate of authority.

Upon receipt of an application for issuance of a certificate of authority, the commissioner

shall issue or deny the same. Issuance of a certificate of authority shall be granted only if

the commissioner finds that the applicant has complied with KRS 304.38 -040 and has

paid the application fee, and the commissioner is satisfied that the following conditions

are met:

(1) The persons responsible for the conduct of the affairs of the application are

competent, trustworthy, and possess good reputations;

(2) The health maintenance organization is financially responsible and may reasonably

be expected to meet its obligations to enrollees and prospective enrollees. In making

this determination, the commissioner may consider:

(a) The financial soundness of the health maintenance organization's

arrangements for health care services and the schedule of charges used in

connection therewith;

(b) The adequacy of working capital;

(c) Any agreement with an insurer, a government, or any other organization for

insuring the pay ment of the cost of health care services or the provision for

automatic applicability of an alternative coverage in the event of

discontinuance of the health maintenance organization or its inability to meet

its financial obligations;

(d) Examples of any a greements with providers for the provision of health care

services by provider type; and

(e) Compliance with KRS 304.38 -070 if the applicant is applying for a health

maintenance organization certificate of authority as a guarantee that the

obligations will be duly performed.