Nev. Admin. Code § 695C.120 - Application: Required documents

An application for a certificate of authority must be accompanied by all forms specifically required by chapter 695C of NRS and provided by the Division and by:

1. All documents describing the financing and ownership of the organization, including financial statements and copies of any contracts made or to be made between any member of the governing board or committee, the officers of the corporation or partners of a partnership or association, or providers, and the proposed organization. The financial statements must depict a net worth of not less than $1,500,000 for a health maintenance organization. All financial statements must be certified by an independent certified public accountant.

2. For a health maintenance organization, a surety bond or deposit of cash or securities to secure the debts of the health maintenance organization and for the protection of the enrollees in the amount of $250,000 or more which is deposited with the Commissioner. The bond must include a provision preventing cancellation except after written notice to the Commissioner of not less than 90 days. A health maintenance organization which has made a deposit of securities pursuant to this subsection may withdraw them if it makes an equivalent deposit of cash, securities or a combination of cash and securities acceptable to the Commissioner.

3. For a health maintenance organization, blanket fidelity coverage issued by an authorized insurer in an amount of not less than $1,000,000 in the aggregate to cover every director, officer, partner and employee of the health maintenance organization who may receive, collect, disburse or invest funds in connection with the activities of the health maintenance organization.

4. A proposed plan of operation for the first 3 years of operation based on projected total income and projected total expenses. The amounts stated for the cost of medical services and the use of them in the proposed plan must be certified by a qualified actuary. The plan must project income and expected costs allocated to:

(a) Coverage for emergencies or medically necessary services rendered outside of the specified geographic area of service of the organization;

(b) Per capita payments to primary physicians;

(c) Fees to other providers of health care;

(d) Supplemental benefits;

(e) A contract of stop-loss insurance;

(f) Expenses of administration; and

(g) Amortization of necessary costs for the establishment of the organization.

Notes

Nev. Admin. Code § 695C.120

Comm'r of Insurance, LH-4 § III, eff. 7-1-74-NAC A 6-11-86; 10-29-96; R148-99 & R194-99, 1-27-2000; R248-03, 11-12-2004

NRS 679B.130, 695C.070, 695C.270, 695C.275