354.704. Application for certificate of authority, content.

MISSOURI STATUTES AND CODES

354.704. Application for certificate of authority, content.

Application for certificate of authority, content.

354.704. An application for a certificate of authority tooperate a prepaid dental plan corporation in this state shall befiled with the director on a form prescribed by the director.Such application shall be verified by an officer or authorizedrepresentative of the applicant and shall set forth, or beaccompanied by, the following:

(1) A duly certified copy of the corporation's articles ofincorporation or articles of association with all amendments;

(2) A copy of the corporation's bylaws or regulationsgoverning the conduct of the internal affairs of the corporation;

(3) A list of the names, addresses, and official positionsof the persons who are responsible for the conduct of the affairsof the corporation, including all members of the board ofdirectors;

(4) A copy of any contract made or to be made between anyproviders and the applicant;

(5) A statement generally describing the prepaid dental planto be offered and the corporation's facilities and personnel;

(6) A copy of contracts and contract certificates to beissued to the enrollees;

(7) A copy of any group enrollee contract which is to beissued;

(8) Financial statements showing the applicant's assets,liabilities, and sources of financial support. If theapplicant's financial affairs are audited by independentcertified public accountants, a copy of the applicant's mostrecent regular certified financial statement shall satisfy thisrequirement unless the director determines that additional ormore recent financial information is required;

(9) A description of the proposed method of marketing theprepaid dental plan, a financial plan which includes a three-yearprojection of the initial operating results anticipated, and astatement as to the sources of funding;

(10) A description of the procedures to provide emergencydental benefits;

(11) A statement reasonably describing the geographic areato be served;

(12) A fee of two hundred dollars for issuance of acertificate of authority; and

(13) Such other information as the director may require.