# N.D. Cent. Code § 26.1-18.1-02: 26.1-18.1-02. Establishment of health maintenance organizations

> North Dakota · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-02

## Section

- **Citation:** N.D. Cent. Code § 26.1-18.1-02
- **Heading:** 26.1-18.1-02. Establishment of health maintenance organizations
- **Jurisdiction:** North Dakota
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** ND Code / Title 26.1 / Chapter 26.1-18.1 / Section 26.1-18.1-02

## Text

26.1-18.1-02. Establishment of health maintenance organizations

1. Notwithstanding any law of this state to the contrary, any person may apply to the

commissioner for a certificate of authority to establish and operate a health

maintenance organization in compliance with this chapter. No person may establish or

operate a health maintenance organization in this state without obtaining a certificate

of authority under this chapter. A foreign corporation may qualify under this chapter,

subject to obtaining a certificate of authority as a foreign corporation under section

10-19.1-136 and compliance with all provisions of this chapter and other applicable

state laws.

2. Any health maintenance organization that has not previously received a certificate of

authority to operate as a health maintenance organization as of August 1, 1993, shall

submit an application for a certificate of authority under subsection 3 within thirty days

of August 1, 1993. Each applicant may continue to operate until the commissioner acts

upon the application. In the event that an application is denied under section

26.1-18.1-03, the applicant must thereafter be treated as a health maintenance

organization whose certificate of authority has been revoked.

3. Each application for a certificate of authority must be verified by an officer or

authorized representative of the applicant, must be in a form prescribed by the

commissioner, and must set forth or be accompanied by the following:

a. A copy of the organizational documents of the applicant, such as the articles of

incorporation, articles of association, partnership agreement, trust agreement, or

other applicable documents, and all amendments thereto.

b. A copy of the bylaws, rules, and regulations, or similar document, if any,

regulating the conduct of the internal affairs of the applicant.

c. A list of the names, addresses, and official positions and biographical information

on forms acceptable to the commissioner of the persons who are to be

responsible for the conduct of the affairs and day-to-day operations of the

applicant, including all members of the board of directors, board of trustees,

executive committee, or other governing board or committee and the principal

officers in the case of a corporation, or the partners or members in the case of a

partnership or association.

d. A copy of any contract form made or to be made between any class of providers

and the health maintenance organization and a copy of any contract made or to

be made between third-party administrators, marketing consultants, or persons

listed in subdivision c and the health maintenance organization.

e. A copy of the form of evidence of coverage to be issued to the enrollees.

f. A copy of the form of group contract, if any, which is to be issued to employers,

unions, trustees, or other organizations.

g. Financial statements showing the applicant's assets, liabilities, and sources of

financial support, including both a copy of the applicant's most recent and regular

certified financial statement and an unaudited current financial statement.

h. A financial feasibility plan that includes detailed enrollment projections, the

methodology for determining premium rates to be charged during the first twelve

months of operations certified by an actuary or other qualified person, a

projection of balance sheets, cash flow statements showing any capital

expenditures, purchase and sale of investments and deposits with the state, and

income and expense statements anticipated from the start of operations until the

organization has had net income for at least one year, and a statement as to the

sources of working capital as well as any other sources of funding.

i. A power of attorney duly executed by the applicant, if not domiciled in this state,

appointing the commissioner and the commissioner's successors in office, and
d

income and expense statements anticipated from the start of operations until the

organization has had net income for at least one year, and a statement as to the

sources of working capital as well as any other sources of funding.

i. A power of attorney duly executed by the applicant, if not domiciled in this state,

appointing the commissioner and the commissioner's successors in office, and

duly authorized deputies, 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 health maintenance organization on a cause of action arising in this

state may be served.

j. A statement or map reasonably describing the geographic area or areas to be

served.

k. A description of the internal grievance procedures to be utilized for the

investigation and resolution of enrollee complaints and grievances.

l. A description of the proposed quality assurance program, including the formal

organizational structure, methods for developing criteria, procedures for

comprehensive evaluation of the quality of care rendered to enrollees, and

processes to initiate corrective action and re-evaluation when deficiencies in

provider or organizational performance are identified.

m. A description of the procedures to be implemented to meet the protection against

insolvency requirements in section 26.1-18.1-12.

n. A list of the names, addresses, and license numbers of all providers with which

the health maintenance organization has agreements.

o. Such other information as the commissioner may require to make the

determinations required in section 26.1-18.1-03.

4. a. The commissioner may adopt rules as the commissioner deems necessary to the

proper administration of this chapter to require a health maintenance

organization, subsequent to receiving its certificate of authority, to submit the

information, modifications, or amendments to the items described in subsection 3

to the commissioner, either for the commissioner's approval or for information

only, prior to the effectuation of the modification or amendment, or to require the

health maintenance organization to indicate the modifications to the

commissioner at the time of the next succeeding site visit or examination.

b. Any modification or amendment for which the commissioner's approval is

required is deemed approved unless disapproved within thirty days, provided that

the commissioner may postpone the action for such further time, not exceeding

an additional thirty days, as necessary for proper consideration.

## Nearby sections

- [N.D. Cent. Code § 26.1-18.1-01 26.1-18.1-01. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-01.md)
- [N.D. Cent. Code § 26.1-18.1-02 26.1-18.1-02. Establishment of health maintenance organizations](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-02.md)
- [N.D. Cent. Code § 26.1-18.1-03 26.1-18.1-03. Issuance of certificate of authority](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-03.md)
- [N.D. Cent. Code § 26.1-18.1-03.1 26.1-18.1-03.1. Bond or insurance requirement](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-03.1.md)
- [N.D. Cent. Code § 26.1-18.1-04 26.1-18.1-04. Powers of health maintenance organizations](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-04.md)
- [N.D. Cent. Code § 26.1-18.1-05 26.1-18.1-05. Fiduciary responsibilities](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-05.md)
- [N.D. Cent. Code § 26.1-18.1-06 26.1-18.1-06. Quality assurance program](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-06.md)
- [N.D. Cent. Code § 26.1-18.1-07 26.1-18.1-07. Requirements for group contract, individual contract, and evidence of coverage](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-07.md)
- [N.D. Cent. Code § 26.1-18.1-08 26.1-18.1-08. Annual report](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-08.md)
- [N.D. Cent. Code § 26.1-18.1-09 26.1-18.1-09. Information to enrollees or subscribers](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-09.md)
- [N.D. Cent. Code § 26.1-18.1-10 26.1-18.1-10. Grievance procedures](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-10.md)
- [N.D. Cent. Code § 26.1-18.1-11 26.1-18.1-11. Investments](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-11.md)
- [N.D. Cent. Code § 26.1-18.1-12 26.1-18.1-12. Protection against insolvency](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-12.md)
- [N.D. Cent. Code § 26.1-18.1-13 26.1-18.1-13. Uncovered expenditures insolvency deposit](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-13.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-18.1_S26.1-18.1-02. Check the current official text before relying on it. Not legal advice.
