W. Va. Code R. § 114-46-4

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-46-4 - Annual Financial Statement

4.1. Each annual financial statement submitted by a health maintenance organization to the commissioner shall include, but not be limited to:

a. A financial statement on a West Virginia statutory accounting basis of the organization, including its balance sheet and receipts and disbursements for the preceding year certified by an independent certified public accountant, reflecting at least (i) all prepayment and other payments received for health care services rendered; (ii) expenditures to all providers, by classes or groups of providers, and insurance companies or nonprofit health service plan corporations engaged to fulfill obligations arising out of the health maintenance contract; and (iii) expenditures for capital improvements, or additions thereto, including, but not limited to, construction, renovation or purchase of facilities and capital equipment;

b. The number of new enrollees enrolled during the year, the number of enrollees as of the end of the year and the number of enrollees terminated during the year, using the "Health Maintenance Organization County Enrollment Worksheet Form" provided by the Insurance Commissioner;

c. A summary of information compiled in such form as may be required by the West Virginia department of health and human resources or other accredited entity, relating to the cost of the health maintenance organization's operations, the pattern of utilization of its services and the quality, availability and accessibility of its services;

d. report of the names and residence addresses of all persons responsible for the conduct of the health maintenance organization's affairs, including all officers of the health maintenance organization, members of its board of directors or other governing body, providers and persons owning five percent (5%) or more of the health maintenance organization, who were associated with the health maintenance organization during the preceding year, and the amount of wages, expense reimbursements, or other payments to those individuals for services to the health maintenance organization, including a full disclosure of any contract or financial arrangement between that person and the health maintenance organization during the preceding year; and

e. such other information relating to the health maintenance organization as the commissioner may request during review of the financial statement.

W. Va. Code R. § 114-46-4