Florida Statutes 1983, Volume 3 - Florida State University College of ...

F.S.1983 HEALTH CARE SERVICE PROGRAMS Ch.641
(13) "Uncovered expenditures" means the cost of
health care services that are covered by a health
maintenance organization, for which a subscriber
would also be liable in the event of the insolvency of
the organization.
History.-s. 3, ch. 72·264; s. 1, ch. 76·33; s. 3, ch. 76-168; s. 1, ch. 77-457; ss.
2, 3, ch. 81-318; ss. 780, 804, 809(lst), ch. 82-243; s. 1, ch. 83-198; s. 137, ch.
83-216. ·
'Note.-Expires October 1, 1991, pursuant to s. 809(lst), ch. 82-243, and is
scheduled for review pursuant to s. 11.61 in advance of that date.
1641.21 Application for certificate.-Before
any entity may operate a health maintenance organization,
it shall obtain a certificate of authority from
the department. Each application for a certificate
shall be on such form as the department shall prescribe
and shall be accompanied by the following:
(1) A copy of the basic organizational document
of the applicant, if any, such as the articles of incorporation,
articles of association, partnership agreement,
trust agreement, or other applicable document,
and all amendments thereto;
(2) A copy of the bylaws, rules and regulations, or
similar form of document, if any, regulating the conduct
of the affairs of the applicant;
(3) A list of the names, addresses, and official capacities
with the organization of the persons who are
to be responsible for the conduct of the affairs of the
health maintenance organization, 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.
Such persons shall fully disclose to the department
and the governing body of the health maintenance
organization the extent and nature of any contracts
or arrangements between them and the health maintenance
organization, including any possible conflicts
of interest;
(4) A statement generally describing the health
maintenance organization, its operations, the manner
in which comprehensive health services will be regularly
available, the location of the facilities at which
comprehensive health care services will be regularly
available to subscribers, the type of health care personnel
engaged to provide the comprehensive health
care services, and the quantity of personnel of each
type;
(5) Forms of all health maintenance contracts the
applicant proposes to offer the 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 such contract;
(6) A statement describing with reasonable certainty
the geographic area or areas to be served by
the health maintenance organization; and
(7) A financial statement prepared on the basis of
generally accepted accounting principles, except that
surplus notes acceptable to the department and
meeting the requirements of this act may be included
in the calculation of surplus.
History.-s. 5, ch. 72-264; s. 3, ch. 76-168; s. 1, ch. 77-457; ... 2,3, ch. 81-318;
... 782, 804, 809(lst), ch. 82-243; s. 2, ch. 83-198.
'N ote.-Expires October 1, 1991, pursuant to s. 809(lst), ch. 82-243, and is
scheduled for review pursuant to s. 11.61 in advance of that date.
application to any entity filing a completed application
in conformity with s. 641.21, upon payment of
the prescribed fees and upon the department's being
satisfied that:
(1) The entity proposes to establish and operate
a bona fide health maintenance organization having
the capability to provide comprehensive health care
services in the geographic area proposed, as certified
by the Department of Health and Rehabilitative Services
as a condition precedent to the issuance of any
certificate.
(2) The proposed rates are actuarially sound for
the benefits provided, including administrative costs.
(3) Before December 31, 1985, the health maintenance
organization has a minimum surplus of
$100,000 and, after December 31, 1985, the health
maintenance organization has a minimum surplus as
follows:
(a) As of December 31, 1986, $150,000;
(b) As of December 31, 1987, $200,000;
(c) As of December 31, 1988, $250,000.
In lieu of having a minimum surplus, the health
maintenance organization may have a written guarantee
insuring the payment of covered subscriber
claims which guarantee is provided by an entity
which has been in operation for at least 3 years and
has a surplus, not including land, buildings, and
equipment, equal to 2 times the statutory surplus deficiency
or 2 times the statutory requirement, whichever
is the greater amount. Such guaranteeing organization
and the written guarantee must be acceptable
to and approved by the Department of Insurance.
(4) The health maintenance organization has
made acceptable arrangements to provide all health
care services offered.
(5) The terms of the contracts such entity proposes
to offer to subscribers will in fact assure that
the comprehensive health care services required by
such subscribers will be rendered under reasonable
standards of quality of care, as certified by the Department
of Health and Rehabilitative Services.
(6) The procedures for offering comprehensive
health care services and offering and terminating
contracts to subscribers will not unfairly discriminate
on the basis of age, sex, race, health, or economic status.
However, this section shall not prohibit reasonable
underwriting classifications for the purposes of
establishing contract rates, nor shall it prohibit experience
rating.
(7) The entity furnishes evidence of adequate insurance
coverage or an adequate plan for
self-insurance to respond to claims for injuries arising
out of the furnishing of comprehensive health care.
(8) The entity has provided, through contract or
otherwise, for periodic review of its medical facilities
and services.
(9) The ownership, control, or management of the
entity is competent and trustworthy and possesses
managerial experience that would make the proposed
health maintenance organization operation beneficial
to the subscribers. The department shall not grant or
1641.22 Issuance of certificate of authority. continue authority to transact the business of a
-The department shall issue a certificate of authori- health maintenance organization in this state at any
ty within 60 days of the filing of a properly completed time during which it has good reason to believe that
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