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(215 ILCS 125/2-2) (from Ch. 111 1/2, par. 1404)
Sec. 2-2. Determination by Director.
(a) Upon receipt of an application for issuance of a certificate of
authority, the Director shall transmit copies of such application and
accompanying documents to the Director of the Illinois Department of Public
Health. The Director of the Department of Public Health shall then
determine whether the applicant for certificate of authority, with respect
to health care services to be furnished: (1) has demonstrated the
willingness and potential ability to assure that such health care service
will be provided in a manner to insure both availability and accessibility
of adequate personnel and facilities and in a manner enhancing
availability, accessibility, and continuity of service; and (2) has
arrangements, established in accordance with regulations promulgated by the
Department of Public Health for an ongoing quality of health care assurance
program concerning health care processes and outcomes. Upon investigation,
the Director of the Department of Public Health shall certify to the
Director whether the proposed Health Maintenance Organization meets the
requirements of this subsection (a). If the Director of the Department of
Public Health certifies that the Health Maintenance Organization does not
meet such requirements, he shall specify in what respect it is deficient.
(b) Issuance of a certificate of authority shall be granted if the
following conditions are met:
(1) the requirements of subsection (c) of Section 2-1 |
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(2) the persons responsible for the conduct of the
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| affairs of the applicant are competent, trustworthy, and possess good reputations, and have had appropriate experience, training or education;
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(3) the Director of the Department of Public Health
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| certifies that the Health Maintenance Organization's proposed plan of operation meets the requirements of this Act;
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(4) the Health Care Plan furnishes basic health care
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| services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for co-payments or deductibles as authorized by this Act;
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(5) the Health Maintenance Organization is
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| financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees; in making this determination, the Director shall consider:
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(A) the financial soundness of the applicant's
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| arrangements for health services and the minimum standard rates, co-payments and other patient charges used in connection therewith;
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(B) the adequacy of working capital, other
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| sources of funding, and provisions for contingencies; and
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(C) that no certificate of authority shall be
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| issued if the initial minimum net worth of the applicant is less than $2,000,000. The initial net worth shall be provided in cash and securities in combination and form acceptable to the Director;
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(6) the agreements with providers for the provision
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| of health services contain the provisions required by Section 2-8 of this Act; and
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(7) any deficiencies identified by the Director have
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(Source: P.A. 100-63, eff. 8-11-17.)
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