Multiple Employer Welfare Arrangement (MEWA)
To register as a Multiple Employer Welfare Arrangement (MEWA) please submit the application in a three-ring binder tabbed according to the list of required items in the application.
Each application question must be completed in full. Attach a separate sheet of paper, properly signed, if additional space is needed.
NOTE: The word "registrant" refers to the MEWA making application.
Forms:
- Application - Form M100 (Item 1)
- Biographical Affidavit (originally signed and notarized) - (Item 15)
- Organizational Requirements Checklist - Form M200 - (Item 17)
- MEWA Coverage Affidavit - Form M500 - Item 18
- MEWA Coverage Requirements Checklist - Form M300 - Item 19
- Management Discussion & Analysis
Upon receipt of application an invoice will be sent for the registration fee of $350. Payment will be remitted electronically via NAIC OPTins payment system. You will need to start setup of the account as it may take up to 3 weeks to complete.
Send the completed application and information via email to Connie Wright at cowright1@idoi.in.gov.
After IDOI receives the proper filing and review is completed, a letter of registration will be prepared and sent to the contact person listed on the application.
Once a MEWA has been registered, Annual and Quarterly filings are required per 760 IAC 1-68-9.