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.
- Foreign Corporations:
- Certificate of Authority, from the Secretary of State, to transact business in Indiana
- 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.
- All affiliated agreements currently in effect.
- Return the Company's current Indiana Certificate of Authority.
- Provide the Company's reason(s) for re-domestication to Indiana.
- A non-objection letter from the Company's current state of domicile, regarding re-domestication to Indiana.
- Board of Directors' resolution approving the Company's re-domestication to Indiana.
- Oath of Office by the directors and officers originally signed and notarized.
- Indiana Biographical Affidavit
The information requested in the preceding should be delivered to the following:
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.