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Managed Care Organization Additional Information

In order to apply for admission as a managed care or limited managed care insurer it will be necessary to file the items listed below:

  1. A statement describing the MCO, its health care plan or plans, facilities and personnel.
  2. A copy of any contract made or to be made between the MCO and any provider.
  3. A copy of any contract between the MCO and any of the company’s board of directors, board of trustees, if a corporation, and the partners or members if a partnership or association.
  4. A copy of each form of health care contract proposed to be issued.
  5. A description of the proposed method of marketing the plan.
  6. A statement of geographic area or areas to be served.
  7. A description of the grievance procedures as required under Section 41-3918, Idaho Code.
  8. A description of the system and procedures for monitoring the quality of health care services as required by Section 41-3905(6)(a), Idaho Code.
  9. A description of the mechanism by which members will be given an opportunity to participate in matters of policy and operation as required by Section 41-3916, Idaho Code.

Items 3 through 9 are not required for Prescription Drug Plans seeking licensure as a Limited Managed Care Organization.