Accredited Reinsurers

• Accredited Reinsurer Packet[pdf]
• Agreement to Maintain Special Deposit due to non-qualified Report of Examination[pdf]

 

Charitable Gift Annuities

• Charitable Gift Annuity Application Packet [pdf]
• Charitable Gift Annuity Issuer Annual Report Form
• Insurance Company Licenses[pdf]

 

County Mutual Insurance Companies

• County Mutual Annual Statement Instructions [MS Word Format]

• County Mutual Annual Statement Form [MS Excel]
• County Mutual Annual Premium Tax Form [pdf]

• County Mutual Quarterly Premium Tax Form [pdf]

 

External Review Organizations

• External Review Organizations Application Packet

• External Review Organizations Approved List

 

MEWA

• MEWA Application [pdf]

 

Preferred Provider Organizations

• Preferred Provider Organization Transparency Act

• List of Registered Preferred Provider Organizations in Tennessee

 

Prepaid Limited Health Service Organizations

• Prepaid Limited Health Service Organization Packet [pdf]

 

Prescription Drug Discount Plan Operators

• Prescription Drug Discount Plan Application
• Prescription Drug Discount Plan Renewal Application
• Registered Prescription Drug Discount Plan Operators

 

Risk Purchasing Groups

• Application for Risk Purchasing Group [pdf]

 

Risk Retention Groups

• Application for Risk Retention Group [pdf]

 

Tax prepration Service Companies

• Tax Preparation Service Company Bond

 

Third Party Administrators

• Third-Party Administrators Packet [pdf]

 

Utilization Review Organizations

• 2013 Utilization Review Application Packet [pdf]

 

Miscellaneous Forms

• Acquisition of Company [pdf]
• Addition of Class of Business [pdf]
• Affidavit of Lost or Misplaced Certificate of Authority [pdf]
• Amendments to Certificate of Authority[pdf]
• Company Conversion [pdf]
• Company Merger [pdf]
• Company Redomestication Requirements[pdf]
• Name Change [pdf]
• Service of Process[pdf]
• Statutory Address Change [pdf]
• Warrantor's Initial Registration (Vehicle Protection Act) [MS Word Format] [pdf Format]
• Warrantor's Registration Renewal [MS Word Format] [pdf Format]

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