210 Neb. Admin. Code, ch. 47, § 004

Current through September 17, 2024

Section 210-47-004 - Application for certificate of authority

A risk management pool organized pursuant to the Intergovernmental Risk Management Act may apply to the director for a certificate of authority to provide group self-insurance to its members. The application shall include the pool's name, location of its principal office, date of organization, and the name and address of each member. The following information shall be submitted with the application, and shall specify the types of coverage involved, where applicable:

004.01 A copy of the agreement entered into for the purpose of establishing and operating a risk management pool as required by Neb.Rev.Stat. § 44-4306;

004.02 A copy of the pool's articles of incorporation, articles of association or by-laws;

004.03 Disclosure of the lines of insurance coverage to be provided as specified under Neb.Rev.Stat. § 44-4304;

004.04 Pro forma financial statements and projections for at least the first 5 years of operation;

004.05 Historical and expected loss experience of the proposed members to the extent reasonably available;

004.06 Appropriate actuarial opinions by a qualified, independent actuary, including a determination of minimum premium or participation levels required to begin operations and to prevent the pool from being hazardous to the public;

004.07 A copy of the agreement with any administrator or service company and biographical information on such individuals or if an entity, the individuals providing the services for such entity;

004.08 Address in Nebraska where books and records of the pool will be maintained at all times;

004.09 Disclosure of proposed standard insurance, excess insurance, excess stop-loss reinsurance arrangements, and reinsurance arrangements and a copy of such agreements as they become available;

004.10 Disclosure of member contribution levels and the criteria used to determine the contribution levels;

004.11 A copy of any insuring agreements, forms and certificates of insurance coverage to be issued by the pool to each member of the pool;

004.12 Disclosure of the extent to which initial pool funding will be raised through the issuance of bonds; and

004.13 Such other information as the director may reasonably require.

210 Neb. Admin. Code, ch. 47, § 004

Amended effective 11/19/2022