17:48F-3 Application for certificate of authority, requirements.
3. Each application for a certificate of authority to operate a prepaid prescription service organization shall be made to the commissioner on a form prescribed by the commissioner, shall be certified by an officer or authorized representative of the applicant, and shall include the following:
a. A copy of the applicant’s basic organizational document, such as the articles of incorporation, if a corporation, articles of association, partnership agreement, management agreement, trust agreement, or other applicable documents and all amendments to such documents;
b. A copy of the executed bylaws, rules and regulations, or similar documents, regulating the conduct of the applicant’s internal affairs;
C. A list, in a form approved by the commissioner, of the names, addresses, and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including, but not limited to, the members of the board of directors, executive committee or other governing board or committee, the principal officers, and any person or entity owning or having the right to acquire 10% or more of the voting securities of the applicant; in the case of a partnership or association, the names of the partners or members; each person who has loaned funds to the applicant for the operation of its business; and a statement of any criminal convictions or enforcement or regulatory action taken against any person who is a member of the board, the executive committee or other governing board or committee, or the principal officers;
d. A statement generally describing the applicant, its facilities, personnel, and the prescription services to be offered by the organization;
e. A copy of the standard form of any contract made or to be made between the applicant and any providers relative to the provision of prescription services to enrollees or contract holders;
f. A copy of the form of any contract made or to be made between the applicant and contract holders or prospective contract holders;
g. A copy of the applicant’s most recent financial statements audited by an independent certified public accountant. If the financial affairs of the applicant’s parent company are audited by an independent certified public accountant but those of the applicant are not, then a copy of the most recent audited financial statement of the applicant’s parent company, certified by an independent certified public accountant, attached to which are consolidating financial statements of the applicant, shall satisfy this requirement unless the commissioner determines that additional or more recent financial information is required for the proper administration of this act;
h. A copy of the applicant’s financial plan, including a three-year projection of anticipated operating results, a statement of the sources of working capital, and any other sources of funding and provisions for contingencies;
i. A list of any affiliate of the applicant which provides services to the applicant in this State and a description of any material transaction between the affiliate and the applicant;
j. A schedule of rates and charges;
k. A description of the proposed method of marketing;
l. A description of the complaint procedures instituted by the applicant;
m. A description of the quality control and utilization review procedures established by the applicant;
n. A power of attorney, if the applicant is not domiciled in this State, duly executed by the applicant, appointing the commissioner and his successors in office as the true and lawful attorney of the applicant in and for this State upon whom all lawful process in any legal action or proceeding against the organization on a cause of action arising in this State may be served;
o. A description of the means which will be utilized to assure the availability and accessibility of the services to enrollees;
p. A plan, in the event of insolvency, for continuation of the benefits to be provided for under the contract; and
q. Such other information as may be required by the commissioner.
Original Text maintained by the State of New Jersey:
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