• IDOI Home
• Consumers
  • About Consumers
  • Consumer Alerts
  • Complaints
  • Medical Malpractice
  • Health Insurance
  • Life Insurance
  • Viatical Insurance
  • Auto Insurance
  • Property Insurance
  • Mine Subsidence
  • Title Insurance
  • Bail Bonds
  • Flood Insurance
  • Small Business Insurance
• Producer Licensing
  • Preparing for a License
  • Licensing Requirements
  • Exam Registration & Scheduling
  • Pre-Licensing Providers Test-Pass Ratio
  • Apply/Renew/Edit
  • Request Certification
  • Look For Producer/Agent
• Surplus Lines Licensing
  • About Surplus Lines Licensing
  • Licensing Requirements
  • Exam Registration & Scheduling
  • Apply/Renew/Edit
  • Monthly Affidavits
  • Semi-Annual Premium Tax
  • Annual Filing
• Bail Bond/Recovery Agents Licensing
• Other Agent Types
  • About Other Agent Types
  • Viatical Settlement Declaration
  • Long Term Care Requirements
  • Pre-Licensing Education Providers
  • Continuing Education Providers
• Indiana Political Subdivision Risk Management Commission
• Companies or Entities: Licensed/Registered
  • About Companies or Entities
  • Lists by Type or Category
  • Annual/Quarterly Statement Filing Instructions & Forms
  • Domestic Admission/Re-domestication Requirements
  • Foreign Admission Requirements
  • Corporate Amendment Application
  • Initial Registration Requirements
  • Renewal Requirements
  • Rate & Form Filings
  • Medical Malpractice
  • Complaint Information
  • Producer License Status
  • Registered Agents/Service of Process
  • Fidelity Bond Compliance
  • Report of Securities/Statutory Deposit Instructions & Forms
  • Joint Custodial Agreement Information
  • Look Up Company/Entity
• Healthcare Providers
• Medicare & SHIP
  • About Medicare & SHIP
  • Medicare Coverage
  • Medicare Supplement
  • Informational Brochures
  • Help Paying for your Medicare Costs
  • Long Term Care Insurance
  • State Health Insurance Program (SHIP)
  • Contact a SHIP Volunteer for Assistance
  • SHIP Presentations
  • Helpful Links
  • AskSHIP Newsletter
• SHIP Volunteers
  • About SHIP Volunteers
  • Become a SHIP Volunteer
  • SHIP Volunteer Trainings
  • SHIP Locations
  • SHIP Conference Calls
  • Applying for LIS & MSP
  • Informational Brochures
  • Volunteer Appreciation
• Insurance Laws & Bulletins
• Contact Us

 

 

• Formation - Fraternal, Life, Property & Casualty Insurance Companies or Risk Retention Group
• Formation - Title Insurance Company
• Health Maintenance Organization
• Limited Service Health Maintenance Organization
• Re-domestication to Indiana - Fraternal, Life, Property & Casualty and Title Insurance Companies or Risk Retention Group
• Re-domestication to Indiana - Health Maintenance Organization
• Re-domestication to Indiana - Limited Service Health Maintenance Organization

IDOI provides guidance and forms for obtaining licenses in accordance with statutes and regulations. Specialized licenses have different requirements that must be followed and forms which need to be submitted.

IDOI provides state specific requirements and forms for admission of domestic companies. The requirements and instructions for filing must be met.

Back to top

Formation - Fraternal, Life, Property & Casualty Insurance Companies or Risk Retention Group

The following state specific items 1-4 must be submitted prior to submitting a Uniform Certificate of Authority Application (UCAA). Once item 5 has been issued Company may submit the remaining items with the UCAA Primary Application to obtain a Certificate of Authority.

1. Proof of Publication of Notice of Intention. ( IC 27-1-6-5 IC 27-1-6-7 )
   • Notice of Intention
2. Triplicate originals of Articles of Incorporation. After approval by the Department of Insurance, must also be approved by Attorney General and Secretary of State. ( IC 27-1-6-4 & IC 27-1-6-6)
   • Articles of Incorporation
3. Incorporators Bond in the amount of $10,000 (may be waived if fidelity bond purchased). ( I.C. 27-1-6-11 )
4. An original or certified copy of Fidelity Bond on all officers showing amount of coverage and with endorsement attached specifically naming the insurance company (minimum amount $50,000). Letters or Certificates of Insurance are not acceptable. Coverage may not be written by an affiliate. ( I.C. 27-1-7-14 )
5. A permit for Completion of Organization (issued by the Department). ( I.C. 27-1-6-11 )
6. Minutes of all company meetings held to date, all books or records, stock records, subscription records, etc.( IC 27-1-7-16 )
7. Oath of Office by directors. ( IC 27-1-7-10(i) )
8. The IDOI utilizes the Uniform Certificate of Authority Primary Application

UCAA

Once the Department completes it review, we will prepare a certificate of authority and send it to the contact person listed on the application.

Once Company has received a Certificate of Authority a NAIC company code may be obtained from the:
National Association of Insurance Commissioners (NAIC)
120 West 12th Street, Suite 1100
Kansas City, MO 64105
(816) 842-3600

The information requested in the preceding should be delivered to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787

Back to top

Formation - Title Insurance Company

The following state specific items must be submitted along with the Uniform Certificate of Authority Primary Application (UCAA) in order to obtain a Certificate of Authority.

• Articles of Incorporation approved by the Secretary of State of Indiana, in accordance with I.C. 23-1-3-1 et. seq.
• An original or certified copy of Fidelity Bond on all officers showing amount of coverage and with endorsement attached specifically naming the insurance company (minimum amount $50,000). Letters or Certificates of Insurance are not acceptable. Coverage may not be written by an affiliate. ( I.C. 27-1-7-14 )
• The IDOI utilizes the Uniform Certificate of Authority Primary Application

Once the Department completes its review, we will prepare a certificate of authority and send it to the contact person listed on the application.

Once Company has received a Certificate of Authority a NAIC Company Code may be obtained from the:

National Association of Insurance Commissioners (NAIC)
120 West 12th Street, Suite 1100
Kansas City, MO 64105
(816) 842-3600

The information requested in the preceding should be delivered to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787

Back to top

Health Maintenance Organization

The following state specific items must be submitted along with the Uniform Certificate of Authority Application (UCAA) in order to obtain a Certificate of Authority.

1. Foreign Companies:
   1. Certificate of Authority, from Secretary of State, to transact business in Indiana as a foreign corporation. (IC 27-13-2-3)
   2. Certificate of Deposit from state of domicile showing deposit for benefit of all policyholders. (IC 27-13-13-6(2))
   3. Power of Attorney
   4. Board of Directors' Resolution
2. A Fidelity bond ($250,000 minimum), covering all of the officers and employees of the plan. Must be approved by Board of Directors. ( IC 27-13-5-2 )
3. Minimum net worth of $1.5 million. ( IC 27-13-12-2 )
4. A financial feasibility plan in accordance with IC 27-13-2-5(9).
5. Statements of:
   1. Geographic area to be served, by county ( IC 27-13-2-5(11) )
   2. The company's compliance with Point of Service Products ( IC 27-13-13-8 )
6. A copy of any contract that has been made or is to be made between the HMO and a Third Party Administrator, agent(s) or person(s) identified as members of the governing body and officers responsible for the conduct of the affairs of the applicant. ( IC 27-13-2-5(5) )
7. Evidence of coverage to enrollees with proper identifiable form numbers, to include the following items applicable to the proposed plan: ( IC 27-13-2-5(6)(7) )
   1. Master group contract.
   2. Employee subscription certificate (benefit schedule).
   3. Enrollment application.
   4. Conversion contract.
   5. Conversion benefit schedule.
   6. Individual agreement.
   7. Individual schedule of benefits.
   8. Individual application.
   9. Medicare subscriber agreement.
   10. Medicare schedule of benefits.
   11. All applicable marketing materials.
8. Schedule of rates including: ( IC 27-13-2-5(9)(B) )
   1. Proposed group rates and actuarial justification.
   2. Proposed conversion rates and actuarial justification.
   3. Proposed individual rates and actuarial justification.
9. Provider contracts ( IC 27-13-2-5(4) ) containing appropriate hold harmless language ( IC 27-13-15-1 ) and evidence of intended providers ( IC 27-13-2-5(4) ) (i.e. letters of intent).
10. A statement that waives the corporation's rights under federal bankruptcy laws signed by an officer or other person with the authority to bind the corporation. ( IC 27-13-2-8 )
11. Complaint Summary & Questionnaire for the past 2 years on applicant and applicant's parent.
12. Complaint Summary & Questionnaire
13. A description of the internal procedures to be used by the HMO for the investigation and resolution of the complaints and grievances of enrollees. ( IC 27-13-2-5(12) & IC 27-13-10-1 )
14. A description of the proposed quality management program of the applicant that includes the criteria per ( IC 27-13-6-1 ).
15. A description of the procedures to be implemented to meet the requirements set forth in IC 27-13-12 through IC 27-13-19.
16. A list of the names, addresses and license numbers of providers with whom the HMO has agreements. ( IC 27-13-2-5(15) )
17. The IDOI utilizes the Uniform Certificate of Authority Primary Application.

Once the Department completes its review, we will prepare a certificate of authority and send it to the contact person listed on the application.

Once Company has received a Certificate of Authority a NAIC Company Code may be obtained from the:

National Association of Insurance Commissioners (NAIC)
120 West 12th Street, Suite 1100
Kansas City, MO 64105
(816) 842-3600

The information requested in the preceding should be delivered to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787

Back to top

Limited Service Health Maintenance Organization

The following state specific items must be submitted along with the Uniform Certificate of Authority Primary Application (UCAA) in order to obtain a Certificate of Authority.

1. Foreign Companies:
   1. Certificate of Authority, from Secretary of State, to transact business in Indiana as a foreign corporation. (IC 27-13-2-3)
   2. Certificate of Deposit from state of domicile showing deposit for benefit of all policyholders. (IC 27-13-13-6(2))
   3. Power of Attorney.
   4. Board of Directors' Resolution.
2. A Deposit in the amount of $50,000 held jointly with the applicant and Commissioner for the benefit of Indiana enrollees. ( I.C. 27-13-34-17)
3. Fidelity bond - $50,000 minimum, covering all of the officers and employees of the plan. Must be approved by Board of Directors. ( IC 27-13-34-18 )
4. Minimum net worth equal to the greater of $50,000 or 2.5% of annual gross subscription income. ( IC 27-13-34-16 )
5. A financial plan in accordance with IC 27-13-34-8(10).
6. Statements of:
   1. Geographic area to be served, by county.
   2. The company's compliance with Point of Service Products. ( IC 27-13-34-10(6) )
   3. Acknowledgment that all lawful process in any legal action or proceeding against the applicant on a cause of action arising in Indiana is valid if served in accordance with the Indiana Rules of Trial Procedure. ( IC 27-13-34 )
7. Copies of the form(s) of any contract(s) made or to be made between the applicant and any person(s) identified as members of the governing body and officers responsible for the conduct of the affairs of the applicant. ( IC 27-13-34-8(7) )
8. Evidence of coverage to enrollees with proper identifiable form numbers, to include the following items applicable to the proposed plan: ( IC 27-13-34-8(8) )
   1. Master group contract.
   2. Employee subscription certificate (benefit schedule).
   3. Enrollment application.
   4. Conversion contract.
   5. Conversion benefit schedule.
   6. Individual agreement.
   7. Individual schedule of benefits.
   8. Individual application.
   9. All applicable marketing materials.
9. Provider contracts containing appropriate hold harmless language ( IC 27-13-34-12(4) ) and evidence of intended providers (i.e. letters of intent). ( IC 27-13-34-8(5) )
10. A statement that waives the corporation's rights under federal bankruptcy laws signed by an officer or other person with the authority to bind the corporation. ( IC 27-13-34-8(17) )
11. Complaint Summary & Questionnaire for past 2 years on applicant and applicant's parent. ( IC 27-13-34-8(18) )
    • Complaint Summary & Questionnaire
12. A description of the complaint procedures to be established and maintained under IC 27-13-10 & IC 27-13-34-12(1).
13. A description of the quality assessment and utilization review procedures to be used by the applicant. ( IC 27-13-34-8(14) )
14. The IDOI utilizes the Uniform Certificate of Authority Primary Application.

Once the Department completes its review, we will prepare a certificate of authority and send it to the contact person listed on the application.

Once Company has received a Certificate of Authority a NAIC Company Code may be obtained from the:

National Association of Insurance Commissioners (NAIC)
120 West 12th Street, Suite 1100
Kansas City, MO 64105
(816) 842-3600

The information requested in the preceding should be delivered to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787

Back to top

Re-domestication to Indiana - Fraternal, Life, Property & Casualty and Title Insurance Companies or Risk Retention Group

Below are items needed for the review of a company requesting to re-domesticate to Indiana. Items #1 - #10 are to be filed in conjunction with the Uniform Certificate of Authority Primary Application.

Uniform Certificate of Authority Primary Application

1. Most recent Annual Statement filing - Basket Clause (investment listing) in accordance with IC 27-1-12-2(b)(20) for life or fraternal or IC 27-1-13-3(c)(20) for property and casualty and title insurance companies, and risk retention groups.
2. All affiliated agreements currently in effect.
3. Return the Company's current Indiana Certificate of Authority.
4. Provide the Company's reason(s) for re-domestication to Indiana.
5. A non-objection letter from the Company's current state of domicile, regarding re-domestication to Indiana.
6. Board of Directors' resolution approving the Company's re-domestication to Indiana.
7. Notice of Intention - publication.
8. Three (3) copies of the Company's Articles of Incorporation for re-domestication.
9. The Company's By-Laws (if applicable).
10. Oath of Office by the directors and officers originally signed and notarized.

The information requested in the preceding should be delivered to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787

Once the Department completes its review, we will prepare a certificate of authority and send it to the contact person listed on the application.

Back to top

Re-domestication to Indiana - Health Maintenance Organization

Below are items needed for the review of a company requesting to re-domesticate to Indiana. Items #1 - #10 are to be filed in conjunction with the Uniform Certificate of Authority Primary Application.

Uniform Certificate of Authority Primary Application

1. Foreign Corporations:
   1. Articles of Incorporation from the Secretary of State, to transact business in Indiana
2. Most recent Annual Statement filing - Basket Clause (investment listing) in accordance with IC 27-13-11 and IC 27-1-13-3(c)(20) for Health Maintenance Organizations.
3. All affiliated agreements currently in effect.
4. Return the Company's current Indiana Certificate of Authority.
5. Provide the Company's reason(s) for re-domestication to Indiana.
6. A non-objection letter from the Company's current state of domicile, regarding re-domestication to Indiana.
7. Board of Directors' resolution approving the Company's re-domestication to Indiana.
8. Oath of Office by the directors and officers originally signed and notarized.

The information requested in the preceding should be delivered to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787

Once the Department completes its review, we will prepare a certificate of authority and send it to the contact person listed on the application.

Back to top

Re-domestication to Indiana - Limited Service Health Maintenance Organization

Below are items needed for the review of a company requesting to re-domesticate to Indiana. Items #1 - #10 are to be filed in conjunction with the Uniform Certificate of Authority Primary Application.

Uniform Certificate of Authority Primary Application

1. Foreign Corporations:
   1. Certificate of Authority, from the Secretary of State, to transact business in Indiana
2. Most recent Annual Statement filing - Basket Clause (investment listing) in accordance with IC 27-13-11 and IC 27-1-13-3(c)(20) for Health Maintenance Organizations.
3. All affiliated agreements currently in effect.
4. Return the Company's current Indiana Certificate of Authority.
5. Provide the Company's reason(s) for re-domestication to Indiana.
6. A non-objection letter from the Company's current state of domicile, regarding re-domestication to Indiana.
7. Board of Directors' resolution approving the Company's re-domestication to Indiana.
8. Oath of Office by the directors and officers originally signed and notarized.

The information requested in the preceding should be delivered to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787

Once the Department completes its review, we will prepare a certificate of authority and send it to the contact person listed on the application.

 

 

• File a consumer complaint
• File a provider complaint
• Compare Medigap insurance policies
• Apply to be a bail agent

More Online Services »

Top FAQsI Want To...

1. I have a complaint against my insurance company, who do I contact?
2. How do I file a complaint against an insurance company?
3. Where can I find out about insurance law in Indiana?
4. How do I file a complaint against a qualified health care provider?
5. How do I find out more about COBRA coverage?
6. What if I have a self-insured health plan? What is ERISA? Why can't the state de...
7. Am I eligible for Medicare?
8. How can I ensure that I will be notified when updates to Indiana Insurance rules...
9. What does Medicare cover?
10. How much does Medicare cost?

More FAQs »

Top FAQs I Want To...

1. File a complaint.
2. Become an insurance producer.
3. Check out a health care provider.
4. Find a company's registered agent.
5. See a list of licensed insurance companies.
6. File a medical malpractice complaint.
7. Learn about Medicare.
8. Compare Medicare Supplement plans.
9. See what enforcement actions IDOI has taken.
10. Learn about COBRA coverage.
11. Know my HIPAA rights.
12. Form an insurance company.
13. File financial information for my insurance company.
14. Qualify under Indiana's Medical Malpractice Act.
15. Find a bail bond company.
16. Contact SHIP for information.