Issuance of License by Commissioner — Prerequisites

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The commissioner shall issue a license upon compliance with this chapter and other proper requirements of the commissioner, and upon being satisfied that:

  1. The applicant is established as a bona fide nonprofit hospital service corporation with or without the right to provide medical expense indemnity; the hospital service benefits provided by the corporation are not an unnecessary duplication of similar service in the community served; it is desirable for public necessity and convenience; hospital contracts have been obtained, if possible, in the findings of the commissioner, with hospitals representing a majority of the bed capacity in the area where members are to be enrolled; and a fair opportunity has been given to all institutions of standing in the area to be served, to become member hospitals;
  2. A provision has been made in the subscriber's contract authorizing hospital service in hospitals other than participating hospitals, in which case money benefits shall be provided as specified in the subscriber's contract and approved as fair by the commissioner;
  3. Member hospitals of a hospital service plan agree to render service benefits of the plan of which it is a member at the agreed payment schedule to all subscribers; and
  4. The rates charged are fair, reasonable, adequate and not unfairly discriminatory. Benefits to be provided are to be fair, reasonable and not unfairly discriminatory. Rates may differ between subscribers in recognized groups and subscribers not in groups, all subject as above to the approval of the commissioner.


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