N.H. Admin. Code § Ins 3401.04

Current through Register No. 45, November 7, 2024

Section Ins 3401.04 - Purchasing Alliance Application, Licensing and Continuing Review Process

(a) An application shall be completed and filed with the commissioner by an authorized representative of the corporation or other entity established as a precursor to being granted a purchasing alliance license. An application shall not be deemed filed until all information necessary to properly process the application has been received by the commissioner. Upon filing, the commissioner shall make a determination concerning the application and shall provide notice of the determination to the applicant. If approved, a copy of a license shall be provided to the purchasing alliance. The license shall serve as authorization to operate pursuant to this part.

(b) Each applicant shall prepare a business plan as follows:

(1) The business plan shall include, but not be limited to, the following information:

a. A detailed, written plan of operations explaining how the applicant intends to fulfill the purposes and requirements of this part.

b. A written commitment by the alliance;

c. The specific steps planned to increase affordability, efficiency and fairness of health insurance coverage;

d. The specific steps planned to allow small employers and their employees to obtain health insurance that is a better value to them than what is otherwise available;

e. The specific steps planned to provide small employers and their employees meaningful choice of health carriers and health benefit plans, and foster competition based on value;

f. The scope of service to be offered in the proposed service area and the resources and expertise to be used to implement and administer those services;

g. A provision requiring that any coverage procured by the alliance shall include a provision requiring that the members of the alliance be notified directly by the insurer of cancellation due to nonpayment of premium;

h. The personal biographical information and descriptions of the officers of the alliance;

i. A written statement demonstrating that those involved in the operation of the alliance have the expertise and experience to effectively and professionally represent small employers and their eligible employees in a fiduciary capacity; and

j. A affirmative demonstration that financial controls are in place as a condition of licensure; and

(2) Proposed substantive changes in the policy or operations of the business plan shall not take effect without approval from the commissioner.

(c) Each applicant shall file with the commissioner the following information or documents:

(1) A business plan;

(2) A plan that affirmatively demonstrates that the alliance has the technical expertise and capacity to serve a significant group of small employers and their eligible employees over the service area;

(3) A plan that demonstrates that the alliance has the technical capacity to provide service quality throughout the entire service area;

(4) The applicant's articles of incorporation, bylaws or other formation and business operation documents;

(5) A list of officers and directors of the applicant and the contract administrator, if one is employed, and personal biographical information or firm descriptions for each;

(6) Evidence of security and prudence in the accounting, deposit, collection, handling, and transfer of moneys;

(7) A description of the service area in which the alliance will be marketing and offering services; and

(8) An annual report that shows:

a. The alliance is operating in a sound financial fashion;

b. The alliance is not a risk-bearing entity and obtains insurance to cover its member; and

c. The alliance is utilizing sound financial controls and money management.

(d) The commissioner shall approve all assessments made upon member small employers by the alliance for costs incurred or anticipated in connection with the operation of the alliance.

(e) The following acts shall constitute a basis for denial, non-renewal or suspension of an application or existing license, following notice and an opportunity for hearing: If the acts are intentional, they shall constitute a basis for revocation, after notice and hearing.

(1) Failure to comply with the provisions of RSA 420-G;

(2) Failure to comply with the business plan filed and approved by the commissioner;

(3) Failure to maintain adequate financial controls;

(4) Failure to extend alliance health benefit plan coverage to eligible employees;

(5) Failure to comply with a lawful order of the commissioner;

(6) Engaging in an unfair or deceptive act or practice;

(7) Filing any necessary form, including the application form, with the commissioner that contains false or materially incorrect information or omissions; or

(8) Misappropriation, conversion, illegal withholding, or refusal to pay over upon proper demand any moneys that belong to a person or participating carrier and that have been entrusted to the alliance in its fiduciary capacity.

(f) The commissioner shall require the removal and replacement of managerial or marketing staff or third party contractors if necessary to remedy compliance or performance problems.

N.H. Admin. Code § Ins 3401.04

#7434, INTERIM, eff 2-1-01, EXPIRED: 7-31-01

New. #7583, eff 11-1-01; ss by #9564, eff 10-19-09