A. Issuance of a certificate of authority shall be granted within the time prescribed in section 20-216 by the director if the director is satisfied that the following conditions are met:

Terms Used In Arizona Laws 20-1054

  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Health care plan: means any contractual arrangement whereby any health care services organization undertakes to provide directly or to arrange for all or a portion of contractually covered health care services and to pay or make reimbursement for any remaining portion of the health care services on a prepaid basis through insurance or otherwise. See Arizona Laws 20-1051
  • Health care services: means services for the purpose of diagnosing, preventing, alleviating, curing or healing human illness or injury. See Arizona Laws 20-1051
  • Health care services organization: means any person that undertakes to conduct one or more health care plans. See Arizona Laws 20-1051
  • Provider: means any physician, hospital or other person that is licensed or otherwise authorized to furnish health care services in this state. See Arizona Laws 20-1051

1. The persons responsible for conducting the affairs of the health care services organization are competent and trustworthy and are professionally capable of providing or arranging for the provision of health and medical services being offered.

2. The health care services organization constitutes an appropriate mechanism to achieve an effective health care plan pursuant to this title and any rule that is adopted by the director.

3. The health care services organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees. In making this determination, the director may consider:

(a) The financial soundness of the health care plan’s arrangements for health care services and the schedule of charges used in connection therewith.

(b) Any agreement with an insurer, a hospital or a medical service corporation, a government or any other organization for insuring the payment of the cost of health care services or the provision for automatic applicability of an alternative coverage in the event of discontinuance of the plan.

(c) Any agreement with providers for the provision of health care services.

4. Each officer responsible for conducting the affairs of the health care services organization has filed with the director, subject to the director’s approval, a fidelity bond in the amount of fifty thousand dollars.

B. Unless preempted under federal law or unless federal law imposes greater requirements than this section, this section applies to a provider sponsored health care services organization.