Company Licensing Forms & Applications

Insurance Company Licenses

Uniform Certificate of Authority Application (UCAA)

Accredited Reinsurers

Accredited Reinsurer Packet [pdf]

Auto Clubs or Associations

Application for Certificate of Authority [ONLINE]
Application for Auto Club Agent [pdf]

Charitable Gift Annuities

Charitable Gift Annuity Application Packet [ONLINE]
Charitable Gift Annuity Issuer Annual Report Form [pdf]

County Mutual Insurance Companies

County Mutual Annual Statement Instructions [pdf]
County Mutual Annual Statement Form [MS Excel]

Discount Plan Operators

Application for Discount Plan Operators

Employee Leasing

Employee Leasing Licensee Application [ONLINE]
Employee Leasing Renewal Application [ONLINE]
Guaranty Agreement Form [pdf]

External Review Organizations

Health Carrier Grievance Reporting Forms and Procedures

Instructions and Packet [pdf]
Instructions and Packet [word]

MEWA

MEWA Application [pdf]

Pharmacy Benefits Manager ("PBM") Licensing Packet

Pharmacy Benefits Manager (PBM) Licensing Packet [ONLINE]

Prepaid Limited Health Service Organizations

Prepaid Limited Health Service Organization Packet [pdf]

Preferred Provider Organizations

Preferred Provider Organization Application [ONLINE

Risk Purchasing Groups

Application for Risk Purchasing Group [ONLINE]
RPG Secretary's Certificate [pdf]
RPG Service of Process Form [pdf]

Risk Retention Groups

Application for Risk Retention Group [pdf]

Tax Preparation Service Companies

Tax Preparation Service Company Bond [pdf]

Third Party Administrators

Life and Health Third-Party Administrators Packet [ONLINE]
Workers Compensation Third-Party Administrators Packet [ONLINE]

Utilization Review Organizations

Utilization Review Application Packet [pdf]

Vehicle Protection Product

Warrantor's Initial Registration [pdf] (Vehicle Protection Act)
Warrantor's Registration Renewal [pdf]

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