§453.  Certificate of authority

A.  It is unlawful for any self-insurer to transact business or to issue or provide health care benefits under or pursuant to a self-insurance plan in this state without a certificate of authority issued by the commissioner of insurance.  Any self-insurer which transacts business in this state without the certificate of authority required by this Subpart shall be considered an unauthorized insurer within the meaning of Subpart O of this Part, R.S. 22:431 et seq., and Part I of Chapter 7 of this Title, R.S. 22:1901 et seq., and all remedies and penalties prescribed therein shall apply to such self-insurer.

B.  Each application for a certificate of authority shall be made on forms prescribed by the commissioner, shall be verified by the self-insurer or its authorized representative, and shall set forth or be accompanied by all of the following items:

(1)  A copy of the self-insurer's bylaws and all management, administration, or trust agreements which the plan has made or proposes to make for the conduct of its business and affairs. Any proposed change or amendment to the foregoing shall also be filed with the commissioner within sixty days of its implementation.

(2)  A list of names, permanent addresses, and official positions, if any, of the persons responsible for the formation of the self-insurer and for the organization, establishment, administration, and maintenance of the self-insurance plan.

(3)  Biographical background information, on a form prescribed by the commissioner for each person who controls, directly or indirectly, ten percent or more of the self-insurer and for each director and officer of the self-insurer.

(4)  A plan of operation which clearly indicates the method of operation of the self-insurer including all of the following items:

(a)  The types and limits of insurance to be provided.

(b)  Pro forma financial statements for a period covering three years, which shall include a balance sheet, income statement, and cash flow statement.

(c)  The amount and liquidity of its assets relative to the risks to be assumed by the self-insurer.

(d)  The expertise, experience, and character of the persons or entities which will manage the self-insurer.

(e)  A description of the self-insurer's stop-loss or excess program.

(f)  A description of the self-insurer's underwriting policy, including the person or entity which will perform these functions.

(g)  A description of the self-insurer's claims handling procedures, including the person or entity that will perform these functions.

(h)  A description of the self-insurer's investment policy.

(i)  The overall soundness of the plan of operation of the self-insurer.

(j)  A description of the self-insurer's rate-making policies and procedures.

(5)  A feasibility study or other analysis involving the self-insurance plan prepared by a qualified actuary.

(6)  A copy of the application for coverage, contract, certificate, or policy of insurance or schedules of benefits to be issued or provided to persons covered under the self-insurance plan.

(7)  A current financial statement verified by the applicant or its authorized representative showing the applicant's assets, liabilities, and sources of financial means and support.

(8)  A copy of a fidelity bond which bond shall comply with all of the following:

(a)  Provides protection to the self-insurer against acts of fraud or dishonesty by persons servicing the self-insurer.

(b)  Provides coverage for each person responsible for servicing the self-insurer.

(c)  Is in an amount equal to the greater of ten percent of the premiums and contributions received by the self-insurer or ten percent of the benefits paid, during the preceding calendar year, with a minimum amount of ten thousand dollars and a maximum amount of five hundred thousand dollars.

(9)  A copy of all advertising and marketing materials, including the marketing plan.

(10)  A statement by the self-insurer certifying that the self-insurance plan is in compliance with all applicable provisions of the Employee Retirement Income Security Act of 1974 (29 U.S.C. §1001 et seq.).

C.  Within ninety days of receipt of a completed application, the commissioner of insurance shall issue a certificate of authority to do business in the state to an applicant if the commissioner determines that the following conditions are met:

(1)  The persons responsible for the administration of the self-insurance plan are competent, trustworthy, and of good reputation.

(2)  The applicant is financially sound and responsible.

(3)  The applicant has deposited cash or securities and has otherwise complied with all of the requirements of this Subpart.

Acts 1984, No. 857, §1; Acts 1990, No. 902, §1; Redesignated from R.S. 22:3003 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2009, No. 503, §1; Acts 2012, No. 680, §1, eff. June 7, 2012.

NOTE:  Former R.S. 22:453 redesignated as R.S. 22:182 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.