Renewal Requirements
Licensed and authorized entities must complete periodic filings to remain in good standing in Indiana. Requirements vary for each license.
- Discount Medical Program Organization
- Independent Review Organization
- Managing General Agent
- Medical Claims Review
- Multiple Employer Welfare Arrangement (MEWA)
- Professional Employer Organization (PEO)
- Preferred Provider Organization (PPO)
- Reinsurance Intermediary Broker or Manager
- Reinsurers (Accredited)
- Third Party Administrator (TPA)
- Utilization Review
Discount Medical Program Organization
IDOI provide instructions that assist individuals in preparing the application for a discount medical card program organization (DMPO) with all the information required by statute and facilitate expeditious processing of the application by IDOI. The instructions are listed into four categories of information and include:
Section I - Application Fees and Form
Section II - Legal
Section III - Financial and Related Information
Section IV - Forms
Download and print the Application Instructions.
Application
Application Checklist
Discount Medical Program Organization Bond Form
Filing Company Transmittal Document Discount Medical Program Organization Standards
Discount Medical Program Organization Annual Report
Please submit your package in a tabbed binder. Please identify the tabbed sections by the section number reference, e.g. II-2 would contain the By-laws and other legal documents.
Submissions that do not contain all the required information will be returned without review or approval.
Submit the completed application package to:
Indiana Department of Insurance
Company Compliance Services
311 W. Washington Street, #300
Indianapolis, Indiana 46204-2787
Independent Review Organization
EC 27-13-10.1, effective 1/1/2000 for HMOs and IC 27-8-28, effective 7/1/2001 for all issuers of accident and sickness insurance policies, requires that these entities doing business in Indiana establish and maintain an external grievance procedure for the resolution of grievances regarding adverse utilization review determinations, adverse determinations of medical necessity or determinations that a proposed service is experimental or investigational. The Department of Insurance (Department) is required to establish and maintain a process for annual certification of independent review organizations and to maintain a list of certified independent review organizations (IROs) to be used by HMOs and other insurers. Criteria for certification as an IRO were published in Bulletin 99 on November 1, 1999.
- Application Requirements for Registration of Independent Review Organization
- Requirements for renewal of certificate of registration for Independent Review Organization
- Application for Independent Review Organization
- Indiana Independent Review Organization Checklist
Managing General Agent
To successfully apply for Managing General Agent, IDOI provides the following instructions. The requirements must be submitted in order to obtain a Certificate of Registration.
Please number each item in the upper right-hand corner to correspond with its number in this Schedule of Requirements.
1. Each application question must be completed in full. Attach a separate sheet of paper, properly signed, if additional space is needed.
2. Managing General Agent contract per IC 27-1-33-7 and Contract Compliance Checklist. If there have been no changes to the existing agreement(s) or new contracts entered into please provide a signed statement stating contract(s) previously filed is still in effect.
3. Fee of $100, check made payable to IDOI.
4. Annual compilation prepared by an independent certified accountant per IAC 760:1-52-6.
5. A listing of the current officers, directors and biographical affidavits for each newly elected officer, director, or partner of the applicant, originally signed and notarized.
6. Certified copy of fidelity bond and errors and omissions policy. Certificate of Insurance is not acceptable.
7. Certification of Gross Direct Written Premium
8. Proof of licensure as Indiana producer per IC 27-1-15.5
Please submit the application documents to:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787
Medical Claims Review
Application Requirements for Registration of Medical Claims Review Agent are provided by IDOI.
The following items must be submitted in order to obtain a license. Please number each item in the upper right-hand corner to correspond with its number in this Schedule of Requirements.
1. Each application question must be completed in full. Attach a separate sheet of paper, properly signed, if additional space is needed.
2. Application attachments, which include Medical Claims Review checklist and supporting documentation. Complete the “Located” column on the checklist with section and page number of your submission indicating where the item can be found.
a) URAC accreditation does not waive any requirement for documentation submission.
3. Medical claims review plan summary including written screening criteria and review procedures.
4. Toll-free telephone number, hours of operation, contact person and phone number.
5. Confidentiality procedure.
6. Orientation and training of personnel and categories of persons employed for medical review.
7. Statement from a licensed physician that determinations are reviewed with standards and guidelines approved by a licensed physician.
8. Copy of procedures and forms used for notification of determination as per IC 27-8-16-7(7).
9. Signed statement as to your cooperation with the Department of Insurance on investigation of complaints made to the Department.
10. Signed statement that you are in compliance with IC 27-8-16-11 and IC 27-8-16.
11. EIN or FIN number.
12. A renewal fee of $100 will be invoiced during the month of May. Payment should be made in accordance with the invoice instructions and mailed to the post office box address.
Please do not submit your renewal fee with the application material.
For any questions, contact Danielle Fuller at 317-232-4391 or dfuller@idoi.in.gov.
The completed application and information requested above should be sent to the following:
Indiana Department of Insurance
Attn: Medical Claims Review
311 West Washington Street, Ste 300
Indianapolis, Indiana 46204
Multiple Employer Welfare Arrangement (MEWA)
IDOI provides renewal requirements for Multiple Employer Welfare Arrangement. The following items must be submitted within ninety (90) days of the end of the MEWA’s fiscal year in order to obtain a renewal registration.
Please number each item in the upper right-hand corner or place under a tab to correspond with its number in the Schedule of Requirements.
1. Application
2. $100 Internal Audit fee
3. $50 Annual filing fee
4. A report summarizing the business activities of the trust for the immediately preceding year verified by oath of the chair of the board
5. Audited Financial Statement
6. Management Discussion and Analysis instructions
7. Actuarial Opinion including the level of aggregate stop-loss insurance the MEWA maintains
8. Modification to the Plan document along with a certification from the trustees they are in compliance with the minimum requirements of Rule 760 IAC 1-68.
9. Examination Report if applicable
10. Names and addresses of all participating employers
11. Number of covered individuals
Please send the renewal application and information requested to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis IN 46204-2787
Professional Employer Organization (PEO)
Pursuant to IC 27-16, a PEO doing business in Indiana must renew with the Department. There are three ways to renew:
- Registration for a PEO that is domiciled in Indiana, or is located in a state whose licensure or registration requirements are not substantially the same or more restrictive pursuant to IC 27-16-4-6.
- Limited Registration for a PEO that is domiciled in a state other then Indiana whose registration requirements are substantially the same or more restrictive pursuant to IC 27-16-4-6.
- Registration for a PEO that is certified by an approved Independent National Organization
To register a PEO domiciled in Indiana, complete an Application and Biographical Affidavit.
For a limited registration as a PEO you must submit an Application for a limited registration for a PEO that is domiciled in a state other than Indiana
To register a PEO that is certified by an approved Independent National Organization please submit an Application.
Send the completed application and information to:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, IN 46204-2787
Preferred Provider Organization (PPO)
State law requires that each person organizing a preferred provider plan must file with the Commissioner before March 1 of each year a statement, under oath, with information regarding the preferred provider plan.
Download the Preferred Provider Plan Reporting form.
Note: Should the listing of providers be more than fifty pages please submit the information on a CD.
Sherry Barnes
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, IN 46204-2787
Reinsurance Intermediary Broker or Manager
The following items must be submitted in order to obtain a renewal of your Certificate of Registration.
Please number each item in the upper right-hand corner to correspond with its number in this Schedule of Requirements.
1. Each application question must be completed in full. Attach a separate sheet of paper, properly signed, if additional space is needed.
2. Renewal fee of $100, check made payable to IDOI.
3. Statement of financial condition prepared by an independent certified accountant. This statement may be in the form of a compilation report, a report of review or audit report. (Manager only)
4. Copy of organizational chart.
5. A current listing of all officers and directors, and biographical affidavits for each newly elected officer, director, or partner of the MGA since last renewal, originally signed and notarized.
6. Copy of agreement(s), with completed Contract Checklist(s), if new agreements have been entered into or amendments have been made since the last renewal.
a. If no amendments have been made, need signed statement stating contract previously filed is still in effect.
7. Actuarial opinion attesting to the adequacy of loss reserves incurred and outstanding on business produced by RM in accordance with IC 27-6-9-23.
8. Proof of renewal on fidelity bond and errors and omissions policy. Certificate of Insurance is not acceptable. (Manager only)
9. Certification of Annual Reinsurance Premium Managed. (Manager only)
10. Proof of licensure as Indiana producer or reinsurance intermediary broker/manager license in a state with substantially similar reinsurance intermediary laws as Indiana
Send the completed application and information to:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, IN 46204-2787
Reinsurers (Accredited)
IDOI provides a list of items required for accredited reinsurers to renew their registration.
- Annual Statement (including Actuarial Opinion and Management’s Discussion & Analysis) in hard copy form
- Most recent Audited Financial Statement
Notice: Quarterly statements do not need to be filed.
Please submit this information to the attention of:
Pamela Walters
Property & Casualty Supervisor
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787
Third Party Administrator (TPA)
The following items must be submitted in order to renew an insurance administrator license. Please number each item in the upper right-hand corner or place under a tab to correspond with its number in the application and this Schedule of Requirements.
1. Each application question must be completed entirely.
2. Biographical Affidavits for each newly elected officer, director, or partner of the Insurance Administrator originally signed and notarized.
3. Audited Financial Statement prepared by an independent certified public accountant for the two most recent fiscal years (if the applicant has been in business for less than two years submit financial reports that have been prepared in accordance with GAAP and certified by an officer of the applicant). Must be filed by July 1st.
4. Insurance Administrators Compliance Checklist to be completed in conjunction with the submission of any amended or new administrative agreements.
5. Surety Bond if the Insurance Administrator is administering a Governmental Plan and / or Church Plan, if not a statement that Administrator is not administering a Governmental and / or Church Plan.
6. A report detailing the total funds administered for a Governmental Plan and/or Church Plan for Indiana and all other jurisdictions combined.
7. During the month of May you will be invoiced for a registration fee of $50. Please submit to the address shown on the invoice.
Please do not submit fee with the application packet.
8. A report including the complete names and addresses of insurers with which the administrators had an agreement with during the preceding year.
The completed application and information requested above should be sent by May 1st to the following:
Indiana Department of Insurance
Admissions Coordinator
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787
Utilization Review
IDOI provide renewal requirements of Certificate of Registration for the Utilization Review Agent under IC 27-8-17 and applicable regulation IAC 760: 1-46.
The following items must be submitted in order to obtain a renewal of your Certificate of Registration. Please number each item in the upper right-hand corner to correspond with its number in this Schedule of Requirements.
1. Each application question must be completed in full. Attach a separate sheet of paper, properly signed, if additional space is needed.
2. A renewal fee of $100.00 will be invoiced during the month of May. Payment should be made in accordance with the invoice instructions and mailed to the post office box address.
Do not submit your renewal fee with the application material.
3. If there have been any changes in your previously submitted documentation also complete the Utilization Review renewal checklist and supporting documentation. Complete the “Located” column on the checklist with section and page number of your submission where the item can be found, for all items where documentation has changed. Mark all other items on the checklist N/C.
- Medical claims review plan summary including written screening criteria and review procedures.
- Toll-free telephone number, hours of operation, contact person and phone number.
- Confidentiality procedure.
- Orientation and training of personnel and categories of persons employed for medical review.
- Statement from a licensed physician that determinations are reviewed with standards and guidelines approved by a licensed physician.
- Copy of procedures and forms used for notification of determination as per IC 27-8-17-11.
- Signed statement as to your cooperation with the Department of Insurance on investigation of complaints made to the Department.
- Signed statement that you are in compliance with IC 27-8-17-19 and IC 27-8-17
- EIN or FIN number.
URAC accreditation does not waive any requirement for documentation submission.
Download and complete the following forms to fulfill renewal requirements.
For any questions, contact Danielle Fuller at 317-232-4391 or dfuller@idoi.in.gov.
The completed application and information requested above should be sent to the following:
Indiana Department of Insurance
Utilization Review Specialist: Company Compliance Services
311 West Washington Street, Ste 300
Indianapolis, Indiana 46204
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